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1.
In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes. 相似文献
2.
Heart rate variability and apnea during sleep in Down's syndrome 总被引:1,自引:1,他引:0
RAFFAELE FERRI LILIA CURZI-DASCALOVA STEFANO DEL GRACCO MAURIZIO ELIA SEBASTIANO MUSUMECI & SALVATORE PETTINATO 《Journal of sleep research》1998,7(4):282-287
Autonomic system dysfunction has been reported to occur frequently in patients with Down's syndrome (DS) and is constituted mainly by an imbalance between the sympathetic and vagal systems. The analysis of heart rate variability (HRV) during sleep is a quantitative reliable method for studying such a mechanism, but it has not yet been extensively and adequately applied in DS. In this study, HRV during sleep was evaluated in seven DS patients and in six normal controls, by also controlling for the presence of sleep apnea or arousal. The main results were an increased sympathetic function (low-frequency component of HRV) and a decreased vagal activity (high-frequency component of HRV) in DS with respect to normal controls, during apnea-free periods. Moreover, the presence of apnea, in DS, induced a further significant increase in low-frequency and very low-frequency components of HRV during sleep Stage 2. This study provides additional evidence of a brainstem dysfunctioning in DS, responsible for the abnormal imbalance between the sympathetic and vagal systems and confirms the brainstem involvement already suggested in the literature in order to explain brainstem-auditory evoked potential abnormalities and central sleep apnea in these patients. 相似文献
3.
PIERRE-MARC BOULOUX SALVATORE CORSELLO MICHAEL BESSER ASHLEY GROSSMAN 《British journal of clinical pharmacology》1996,42(2):225-232
- Intravenous bolus doses of thyrotrophin releasing hormone (TRH, 50–1000 μg) caused statistically significant, non-dose dependent and transient rises in blood pressure, heart rate and plasma catecholamines in healthy young males.
- Mean peak incremental rises in systolic blood pressure (mean ± s.e. mean) following 50, 200 and 500 μg TRH were 14.3 ± 2.9 mmHg, 15.7 ± 3.2 mmHg and 17.1 ± 3.9 mmHg respectively (all P < 0.05 vs placebo). Mean incremental rises in heart rate for the three doses of TRH were 8.2 ± 2.2 beats min−1, 7.1 ± 1.8 beats min−1, and 1O.7 ± 2.9 beats min−1 respectively (all P < 0.05 vs placebo).
- Following the 50 μg and 1000 μg doses of TRH, plasma noradrenaline and adrenaline rose significantly (P < 0.05) between 4 and 8 min. Mean ± s.e. mean incremental plasma noradrenaline rise following 50, 200 and 1000 μg TRH were 0.4 ± O.13 nmol 1−1, 0.37 ± 0.21 nmol 1−1 and 0.41 ± 0.18 nmol 1−1 respectively. Mean ± s.e. mean incremental rise in adrenaline for the 50, 200 and 1000 μg dose were 0.13 ± 0.04 nmol 1−1, 0.08 ± 0.03 nmol 1−1, and 0.11 ± 0.05 nmol l−1 respectively.
- Following administration of the ganglion blocking drug pentolinium (5 mg) the incremental systolic blood pressure and heart rate rises following 500 μg TRH alone 16.6 ± 2.8 mmHg and 1O.4 ± 3.1 beats min−1 respectively.
- The rises in plasma noradrenaline and adrenaline following TRH were attenuated by prior ganglion blockade.
- α-adrenoceptor blockade with thymoxamine (0.3 mg kg−1 bolus + 0.3 mg kg−1 h−1 infusion), singly and combined with intravenous propranolol (10 mg i.v. over 10 min), did not alter the pressor or tachycardic effects of 500 μg TRH.
- In conclusion, although plasma noradrenaline rises following i.v. TRH, suggesting activation of the sympathetic nervous system, this effect is not responsible for the pressor response to TRH, which appears to be due to either a direct vasoconstrictive effect on the peripheral resistance vessels or a direct inotropic/chronotropic effect on the heart.
4.
RISHI K. SAXENA M.D. IVAN A. D'CRUZ M.D. MARK LITAKER M.S. 《Echocardiography (Mount Kisco, N.Y.)》1991,8(5):517-521
We studied the M-mode and two-dimensional imaging of color Doppler mitral flow in eight patients with pericardial effusion and tamponade, and in ten control subjects. Pulsed-Doppler recordings of mitral flow were also obtained in all. Marked phasic changes (presumably respiratory) were consistently recorded in all patients with tamponade with respect to brightness, hue, width (duration), and length of the M-mode Doppler color stream; in these patients, phasic changes were noted in width, length, and color of the mitral flow stream on the two-dimensionalechocardiographic recording, with reciprocal changes in tricuspid flow. In the normal subjects, only minimal fluctuations in these color Doppler characteristics were present. Phasic differences in flow velocity of mitral flow by pulsed Doppler were found between the tamponade and the control groups. Large phasic fluctuations in various characteristics of color Doppler mitral flow on M-mode and two-dimensional imaging may constitute yet another echocardiographic sign of tamponade. (ECHOCARDIOGRAPHY, Volume 8, September 1991) 相似文献
5.
ANEES THAJUDEEN M.D. WARREN M. JACKMAN M.D. BRIAN STEWART M.S. IVAN COKIC M.D. HIROSHI NAKAGAWA M.D. Ph.D. MICHAEL SHEHATA M.D. ALLEN M. AMORN M.D. AVINASH KALI M.S. EZH LIU M.D. DORON HARLEV M.Sc. NATHAN BENNETT M.Eng. ROHAN DHARMAKUMAR Ph.D. SUMEET S. CHUGH M.D. XUNZHANG WANG M.D. 《Pacing and clinical electrophysiology : PACE》2015,38(6):663-674
6.
IVAN J. BENETT MB ChB MRCP MRCGP M Med Sci Principal in General Practice AVRIL F. DANCZAK BSc MRCP MRCGP Principal in General Practice 《European journal of cancer care》1994,3(2):54-57
Significant Event Analysis can be used to improve the effectiveness of a Primary Health Care Team caring for terminally ill patients. A method of doing this is described in detail. Positive team qualities were confirmed and enhanced. Significant areas for improvement were identified: insufficient information had been given to some key workers, changes in medication had been poorly planned, continuity of care, and emotional and professional support of team members were inadequate. A strategy for change was developed and implemented. Performance was reviewed a year later. It was found that the Significant Event Analysis had caused changes in team practices, and was valid and reliable enough to be used as a tool for improving teamwork in primary care in future. 相似文献
7.
The echocardiographic literature contains exceedingly few reports of mediastinal bronchogenic cyst; in most published cases of this entity, the cysts were imaged by computed tomography or magnetic resonance imaging. Because mediastinal bronchogenic cyst is little known as a cause of cardiorespiratory symptoms, we report such a case. 相似文献
8.
IVAN A. D'CRUZ M.D. DANIEL KLEINMAN M.D. HUSSEIN ABOULATTA M.D. PATRICIA ORANDER R. CHRIS HAND 《Echocardiography (Mount Kisco, N.Y.)》1990,7(1):69-75
A prolonged AC interval, decreased PR - AC interval, and a B-inflection ("bump" or "notch") on the mitral AC slope, have been widely regarded as evidence of abnormally high LVEDP for the last 16 years. However, several groups have questioned the reliability of these signs as predictors of high LVEDP. In 50 patients subjected to LV catheterization, we found no correlation between LVEDP and the AC interval or PR - AC interval. A better correlation was obtained between the presence of a B-inflection and diminished LV ejection fraction on angiocardiography. In our series, the B-inflection was noted in 1/19 patients with LVEDP < 15 mmHg as well as LV ejection fraction > 55%, but it was present in 7/10 patients with LVEDP over 15 mmHg, as well as LV ejection fraction < 55%. When properly recorded, the presence of a B-inflection is a useful sign of significant LV dysfunction. 相似文献
9.
IVAN MOSELEY 《Journal of anatomy》2000,197(3):513-518
10.
ABSTRACT. Jensen IW, Faber J (Department of Endocrinology, Aalborg Hospital North, Aalborg, and Departments of Internal Medicine and Clinical Chemistry, Frederiksberg Hospital, Copenhagen, Denmark). Familial dysalbuminemic hyperthyroxinemia. Acta Med Scand 1987; 221:469–73. A family with familial dysalbuminemic hyperthyroxinemia is described. The syndrome is inherited as an autosomal dominant trait and is characterized by marked elevation of serum thyroxine, due to increased binding of thyroxine to albumin, whereas serum triiodothyronine is normal. Serum free thyroxine is normal when measured with ultrafiltration or equilibrium dialysis, but artefactually high when measured with an analogue assay. The importance of the condition, which is harmless, lies in the misinterpretation of values with subsequent erroneous treatment of thyrotoxicosis. By using an ultrasensitive TSH method it is possible to discriminate between euthyroid and hyperthyroid patients and thereby to avoid incorrect diagnosis in subjects with euthyroid hyperthyroxinemia. 相似文献