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81.
A Sultan C Piot D Mariano-Goulart J P Daures F Comte E Renard A Avignon 《Diabetic medicine》2006,23(4):410-418
AIMS: To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with > or = 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. METHODS: Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5-4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. RESULTS: Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7-18.5)]. Low-density lipoprotein cholesterol > or = 3.35 mmol/l [OR (95% CI) = 7.3; 1.5-34.7] and age > median [OR (95% CI) = 6.0 (1.2-28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides > or = 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8-8.8)]. CONCLUSIONS: Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention. 相似文献
82.
83.
Autotransfusion after open heart surgery: the oxygen delivery capacity of shed mediastinal blood is maintained 总被引:1,自引:0,他引:1
H. Schmidt U. Kongsgaard J. Kofstad O. Geiran H. E. Refsum 《Acta anaesthesiologica Scandinavica》1995,39(6):754-758
Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient-blood, during cardiopulmonary bypass and in the postoperative period.
Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration.
Autotransfusion volume ranged from 450–1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood.
The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion. 相似文献
Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration.
Autotransfusion volume ranged from 450–1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood.
The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion. 相似文献
84.
Stephan E. Maier Harvey E. Cline Ferenc A. Jolesz 《Magnetic resonance in medicine》1995,34(5):706-712
Three dimensional (3D) phase contrast angiograms contain velocity data, which is discarded after the reconstruction of the projections. In extension to earlier work on velocity quantification with ungated 2D phase data, this paper shows that a useful estimate of the average velocity and flow rate can be extracted from ungated 3D phase contrast angiograms. Simulations and experiments in a phantom and in vivo were performed. For pulsatile flow and strong spin saturation, an over-estimation of the flow rate at the net in-flow end of the imaging volume and underestimation at the net out-flow end was observed. Imaging at lower RF tip angles yielded flow rates close to the correct value within the entire imaging volume. In contrast to ungated 2D experiments, the flow rates determined by repeated 3D experiments showed no variation. 相似文献
85.
N. Ya. Kovalenko D. D. Matsievskii Yu. V. Arkhipenko 《Bulletin of experimental biology and medicine》1998,126(4):983-987
Study of the dynamics of cardiac output in rats with different tolerance to acute massive blood loss showed that the pumping
ability of the heart remains intact during the entire posthemorrhagic period in all high-resistant and in 65% low-resistant
rats. In 35% rats that were low-resistant to blood loss, the cardiac output deficiency syndrome developed after cessation
of bleeding against the background fall in arterial pressure and a decrease in the hepatic blood flow, which are the signs
of rapid variant of the dysfunction produced by acute blood loss.
Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 126, No. 10, pp. 384–388, October, 1998 相似文献
86.
87.
Clinical Efficacy of New Antiepileptic Drugs in Refractory Partial Epilepsy: Experience in the United States With Three Novel Drugs 总被引:1,自引:1,他引:0
Jacqueline A. French 《Epilepsia》1996,37(S2):S23-S26
Summary: A number of new antiepileptic drugs (AEDs), including topiramate (TPM), felbamate (FBM), and gabapentin (GBP), are approved or believed to be close to approval for marketing in the United States. Key efficacy findings for these AEDs in refractory partial epilepsy were reviewed. Large and significant drug-placebo differences were observed with TPM in two large dose-finding trials conducted in the United States. The minimal effective dose of TPM in the population studied was determined to be approximately 200 mg/day, and doses above 600 mg/day produced good efficacy but little incremental benefit versus the lower dosages for the overall study population. FBM is active in partial epilepsy, although seizure reduction is less marked and drug interactions complicate the findings. GBP is also active in this population, but only the 1,800 mg/day dosage was significantly better than placebo with respect to percent re-sponders. It may be useful to explore higher dosage ranges for both FBM and GBP if they can be well tolerated. 相似文献
88.
应用99mTc-甲氧基异丁基异腈(MIBI)对29例受检者进行首次通过法心室显像,测定左室射血分数(LVEF),并与同期平衡法心室显像测得的LVEF进行相关分析。结果:首次通过法和平衡法心室显像测得的LVEF分别为(46.5±16.7)%、(49.1±16.1)%(P>0.05)。相关分析结果显示,二者有明显的相关(r=0.787,P<0.01)。结果表明:99mTc-MIBI为心肌显像剂,采用首次通过法心室显像,在观察心肌血流改变的同时,可准确可靠地评价左室收缩功能状态。 相似文献
89.
A. Zuckermann M.D. M. Grimm Regine Ahner Paul Simon Peter Buxbaum G. Laufer E. Wolner 《European Surgery》1996,28(3):176-177
Summary
Background Pregnancy is prossible in female patients who underwent cardiac transplantation but is associated with unpredictable risks.
Methods A 23-year old female patient underwent cardiac transplantation because of dilatative cardiomyopathy.
Results Against our advice, she became pregnant 4 months after transplantation. Following an uneventful pregnancy, spontaneous vaginal
delivery occurred 13 months after transplantation. The patient gave birth to a healthy new-born in good physical condition.
Thereafter, the patient refused to attend any further routine follow-up control. 9 months after delivery, the patient was
admitted to hospital in severe cardiac shock. Biopsy showed a serious, acute rejection which was treated with a course of
methylprednisolone. Clinically, the patient recovered within 1 week, but died from acute myocardial infarction 1 day after
discharge from hospital.
Conclusions Only women without a history of rejection episodes, with good kidney function, good graft function, and high compliance should
be counselled to become pregnant.
相似文献
90.
MICHAL J. KANTOCH ROXANE McKAY MICHAEL J. TYRRELL 《Pacing and clinical electrophysiology : PACE》1993,16(9):1887-1891
An 11-year-old girl who underwent Mustard's operation for complete transposition of the great arteries in infancy, developed Mobitz type II second-degree AV block 81/2 years later. A transvenous, active fixation left ventricular lead was inserted and connected to a rate responsive pacemaker. Two years later the lead dislodged due to the child's growth. A new active fixation electrode was positioned in the left ventricle below the pulmonary valve, leaving an electrode loop in the ventricle. Such an approach may prevent lead dislodgement due to growth after intraatrial repair for transposition of the great arteries, but regular radiological or echocardiographic follow-up of lead position is recommended in these patients. 相似文献