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Paul J. Devlin Brian W. McCrindle James K. Kirklin Eugene H. Blackstone William M. DeCampli Christopher A. Caldarone Ali Dodge-Khatami Pirooz Eghtesady James M. Meza Peter J. Gruber Kristine J. Guleserian Bahaaladin Alsoufi Linda M. Lambert James E. OBrien Erle H. Austin Jeffrey P. Jacobs Tara Karamlou 《The Journal of thoracic and cardiovascular surgery》2019,157(2):684-695.e8
Objective
Arch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality.Methods
From 2005 to 2017, 593 neonates in the Congenital Heart Surgeons' Society Critical Left Heart Obstruction cohort underwent a Norwood procedure. Median follow-up was 3.7 years. Multivariable parametric models, including a modulated renewal analysis, were performed.Results
Of the 593 neonates, 146 (25%) underwent 218 reinterventions for arch obstruction after the Norwood procedure: catheter-based (n = 168) or surgical (n = 50) at a median age of 4.3 months (quartile 1-quartile 3, 2.6-5.7). Interdigitation of the distal aortic anastomosis was protective against arch reintervention. Development of ≥ moderate tricuspid valve regurgitation and right ventricular dysfunction at any point was associated with arch reintervention. Nonsignificant variables for arch reintervention included shunt type and preoperative aortic measurements. Surgical arch reintervention was protective against arch reintervention, but transcatheter reintervention was associated with increased reintervention. Arch reintervention was not associated with increased mortality. There was wide institutional variation in incidence of arch reintervention (range, 0-40 reinterventions per 100 years patient follow-up) and in preintervention gradient (range, 0-64 mm Hg).Conclusions
Interdigitation of the distal aortic anastomosis during the Norwood procedure decreased the risk of arch reintervention. Surgical arch reintervention is more definitive than transcatheter. Arch reintervention after the Norwood procedure is not associated with increased mortality. Serial surveillance for arch obstruction, integrated with changes in right ventricular function and tricuspid valve regurgitation, is recommended after the Norwood procedure to improve outcomes. 相似文献2.
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Stephen Kellett Nigel Beail David W. Newman Pat Frankish 《Journal of Applied Research in Intellectual Disabilities》2003,16(2):127-134
Introduction People with intellectual disabilities are now acknowledged to be susceptible to the full range of mental health disorders. This acknowledgement has resulted in the need to develop and evaluate instruments for the assessment and detection of mental health problems. This research evaluates the use of the Brief Symptom Inventory (BSI) with 200 people with mild intellectual disabilities representing community, clinical and forensic populations. Results and conclusions Results illustrate the reliability of the BSI for each of the groups and demonstrates how the Positive Symptom Total (PST) index effectively discriminates between study groups. Case rates for each group are provided. The study illustrates that the BSI could be employed as a brief multitrait assessment instrument and as a treatment outcome measure with people with an intellectual disability. 相似文献
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The MMPI was administered during the patient-perceived best time of the menstrual cycle and during the patient-perceived worst time of the cycle in order to examine the stability of MMPI profile configurations. Subjects were 214 women who were referred to two metropolitan outpatient premenstrual syndrome (PMS) clinics for moderate to severe premenstrual complaints. This sample was selected from 1,849 intake files after screening by strict selection criteria for PMS. The results indicate that there are wide fluctuations in profile patterns between the best and worst times of the menstrual cycle for a large number of patients. Caution in using the MMPI is strongly advised. 相似文献
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The present study reports the differential effects of pertussis toxin on muscarinic regulation of intracellular Ca2+ and inositol phosphate generation and alpha 2-adrenoceptor-mediated inhibition of cAMP formation in SH-SY5Y human neuroblastoma cells. Carbachol caused a biphasic increase in intracellular Ca2+ (release of internal stores and Ca2+ entry) and a dose-dependent increase in inositol phosphate formation. Pertussis toxin pretreatment did not affect either of these components of the signal transduction pathway but did completely reverse the alpha 2-adrenoceptor-mediated inhibition of forskolin-stimulated cAMP formation. These data indicate that muscarinic regulation of inositol phosphate generation occurs via a pertussis toxin-insensitive G-protein and that Ca2+ entry in these cells may not occur via a G-protein. 相似文献
8.
Anorectal function in the solitary rectal ulcer syndrome 总被引:8,自引:6,他引:2
Nigel R. Womack F.R.C.S. Professor Norman S. Williams M.S. John H. Holmfield Mist John F. Morrison Ph.d. 《Diseases of the colon and rectum》1987,30(5):319-323
The anorectal function of nine patients with solitary rectal ulcer syndrome (SRUS) (5 F: 4 M, median age, 27 (range, 19–41
years) and nine control subjects (5 F: 4 M, median age, 47 (35–66)P<0.01) has been investigated by a new technique that radiologically visualizes the anorectum during voiding of a semisolid
contrast medium, while simultaneously measuring intrarectal pressure and anal sphincter EMG activity. A degree of rectal prolapse
was demonstrated in eight of the SRUS patients; six of these lesions were clinically occult. Abnormal failure of the anal
sphincter to relax on voiding was present in seven of the SRUS patients. These abnormalities resulted in the SRUS patients
requiring a greater increase in intrarectal pressure (median, 100 cm water) to void than the control subjects (median, 65
cm water,P<0.01). This combination of high intrarectal pressure and rectal prolapse during straining seems to be the cause of SRUS
This work was supported by a grant from the Medical Research Council. 相似文献
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