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The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or primary percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.
Pathophysiology
Changes in the definition of terms relating to the diagnosisof myocardial infarction (MI) have evolved by better understandingof the pathophysiology culminating in the new term of acutecoronary syndrome (ACS). Figure 1 illustrates the processesthat occur in the development of an acute coronary event. 相似文献
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The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy
in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery
at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history
and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et
al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically
to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical
junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage
IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation
between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp).
There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site
(Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba,ρ=0.51) and lower Aa,ρ=0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n=33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa,ρ=0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone
prior hysterectomy (n=25) or hysterectomy with anterior and/or posterior colporrhaphy (n=17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall
site (Bb,ρ=0.67 andρ=0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera
on PFF in women with primary or recurrent pelvic organ prolapse.
EDITORIAL COMMENT: The authors seek to evaluate whether physical examination of vaginal prolapse using the POP-Q test correlates
with fluoroscopic findings of visceral position. Surprisingly, little correlation is found, even in previously unoperated
patients. One reason for this lack of correlation between the two modalities of evaluation may lie in the use of two different
fixed points of reference: the POP-Q examination uses the hymen as the fixed point of reference, whereas the investigators
chose to use the posterior edge of the femur as a fixed bony point of reference when evaluating pelvic floor fluoroscopy in
the same patient. The lack of correlation between visual inspection of vaginal wall prolapse and what lies deep to that prolapse
should not be used to invalidate the use of the POP-Q as a means to evaluate pelvic prolapse. Rather, the findings support
the premise behind the ICS/AUGS/SGS committee on pelvic organ prolapse, specifically that clinical pelvic examination of the
vaginal walls looks at surfaces only, and as such cannot determine what, if any, organ lies deep to that surface. 相似文献
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David H. Sutherland Kenton R. Kaufman Marilynn P. Wyatt Henry G. Chambers 《Gait & posture》1996,4(4):269-279
Botulinum A toxin (BOTOX®) was injected into the gastrocnemius muscle of 26 cerebral palsy subjects with equinus gait. All subjects were equinus walkers without fixed contracture of the triceps-surae muscle. Injections were performed at 3 month intervals, if needed, as determined by the treating clinician. There were 14 subjects with spastic hemiplegia, 11 subjects with spastic diplegia and 1 subject with spastic quadriplegia. In the case of those subjects with bilateral equinus gait the dose was divided and given into both the right and left gastrocnemius muscle. Gait analysis data was collected prior to the first injection and subsequently at 3 month intervals for 1 year. Kinematic and electromyographic data was obtained. This data was analyzed to provide objective information about the outcome of treatment. Four subjects moved away and were lost to follow-up. Seven subjects left the study to have surgery. The data collected revealed statistically significant improvements in dynamic ankle dorsiflexion in both stance and swing phases, stride length, and electromyography of the tibialis anterior. There were no complications. While the results of this study are promising, additional prospective studies are needed to determine the feasibility of preventing muscle contractures over a longer time period. Furthermore, there is a need for inclusion of other muscles in future research. Future research should also compare BOTOX® treatment with alternative methods of dealing with muscle spasticity such as: casting, orthotic devices, physical therapy, selective dorsal rhizotomy, and surgical lengthening. 相似文献
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缺血性卒中或短暂性脑缺血发作患者的卒中预防指南 总被引:8,自引:0,他引:8
Ralph L.Sacco Robert Adams Grge Albers Mark J.ALBERTS Oscar Benavente Karen Furie Larry B.Goldstein Philip Gorelick Jonathan Halperin Robert Harbaugh S.Claiborne Johnston Irene Katzan Margaret Kelly-Hayes Edgar J.Kenton Michael Marks Lee H.Schwamm Thomas Tomsick 曹勇军 《中华脑血管病论坛》2006,4(1):21-66
这份新声明旨在为缺血性卒中或短暂性脑缺血发作存活者的缺血性卒中预防提供全面和及时的循证推荐,循证推荐包括对危险因素的控制,动脉粥样硬化性疾病的干预措施,心源性栓塞的抗栓治疗以及非心源性卒中抗血小板药的应用。另外,还为其他多种特殊情况下复发性卒中的预防提供了推荐、包括动脉夹层分离、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中(特别是与妊娠和绝经后激素替代治疗相关卒中),脑出血后肮凝药的应用,以及该指南在高危人群中执行和应用的特殊措施。 相似文献
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Mano J. Thubrikar Michel R. Labrosse Kenton J. Zehr Francis Robicsek Geoffrey G. Gong Brett L. Fowler 《European journal of cardio-thoracic surgery》2005,28(6):850-855
Objective: Valve-sparing surgery can be used in patients with dilated aortic roots and aortic insufficiency (AI) but has not become a common practice, in part because the spared valve may be incompetent. Our goal was to study how the dimensions of the aortic root and leaflets have changed in such patients. Methods: Fourteen patients with dilated aortic root and AI were examined by transesophageal echocardiography. The annulus diameter, sinotubular junction (STJ) diameter, sinus height, leaflet free-edge length, and leaflet height were measured. Correlations among these dimensions and with the AI grades were explored. Measurements were also made in 19 normal human aortic valves from silicone molds. Results: There was no evident change in the average diameter of the annulus between the normal valves and those in the dilated aortic roots. The STJ diameter was obviously increased in the dilated aortic roots; the aortic sinuses also appeared to be taller and the leaflets larger than normal. The leaflet free-edge length, the leaflet height, and the sinus height were found to increase with the dilated STJ diameter. The degree of AI was not found to correlate well with any of the dimensions measured. Conclusions: The dimensions of the leaflets may change parallel to aortic root dilatation with AI. Therefore, during valve sparing, it may be necessary to correct both the dilatation of the root and the leaflet free-edge length to achieve a competent valve. 相似文献