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Primary Indication (primary + indication)
Selected AbstractsLong-Term Effects of Upgrading to Biventricular Pacing: Differences with Cardiac Resynchronization Therapy as Primary IndicationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2010GAETANO PAPARELLA M.D. Background: Few studies have assessed the long-term effects of cardiac resynchronization therapy (CRT) in patients with advanced heart failure (HF) and previously right ventricular apical pacing (RVAP). Aims: To assess the clinical and hemodynamic impact of upgrading to biventricular pacing in patients with severe HF and permanent RVAP in comparison with patients who had CRT implantation as initial therapy. Methods and Results: Thirty-nine patients with RVAP, advanced HF (New York Heart Association [NYHA] III,IV), and severe depression of left ventricular ejection fraction (LVEF) were upgraded to biventricular pacing (group A). Mean duration of RVAP before upgrading was 41.8 ± 13.3 months. Clinical and echocardiographic results were compared to those obtained in a group of 43 patients with left bundle branch block and similar clinical characteristics undergoing "primary" CRT (group B). Mean follow-up was 35 ± 10 months in patients of group A and 38 ± 12 months in group B. NYHA class significantly improved in groups A and B. LVEF increased from 0.23 ± 0.07 to 0.36 ± 0.09 (P < 0.001) and from 0.26 ± 0.02 to 0.34 ± 0.10 (P < 0.001), respectively. Hospitalizations were reduced by 81% and 77% (P < 0.001). Similar improvements in echocardiographic signs of ventricular desynchronization were also observed. Conclusion: Patients upgraded to CRT exhibit long-term clinical and hemodynamic benefits that are similar to those observed in patients treated with CRT as initial strategy. (PACE 2010; 841,849) [source] Factors affecting outcome in liver resectionHPB, Issue 3 2005CEDRIC S. F. LORENZO Abstract Background. Studies demonstrate an inverse relationship between institution/surgeon procedural volumes and patient outcomes. Similar studies exist for liver resections, which recommend referral of patients for liver resections to ,high-volume' centers. These studies did not elucidate the factors that underlie such outcomes. We believe there exists a complex interaction of patient-related and perioperative factors that determine patient outcomes after liver resection. We sought to delineate these factors. Methods. Retrospective review of 114 liver resections by a single surgeon from 1993,2003: Records were reviewed for demographics; diagnosis; type/year of surgery; American Society of Anesthesiologists (ASA) score; preoperative albumin, creatinine, and bilirubin; operative time; intraoperative blood transfusions; epidural use; and intraoperative hypotension. Main outcome measurements were postoperative morbidities, mortalities and length of stay (LOS). Data were analyzed using a multivariate linear regression model (SPSS v10.1 statistical analysis program). Results. Primary indications for resections were hepatocellular carcinoma (HCC) (N=57), metastatic colorectal cancer (N=25), and benign disease (N=18). There were no intraoperative mortalities and 4 perioperative (30-day) mortalities (3.5%). Mortality occurred in patients with malignancies who were older than 50 years. Morbidity was higher in malignant (15.6%) versus benign (5.5%) disease. Complications included bile leak/stricture (N=6), liver insufficiency (N=3), postoperative bleeding (N=2), myocardial infarction (N=2), aspiration pneumonia (N=1), renal insufficiency (N=1), and cancer implantation into the wound (N=1). Average LOS for all resections was 8.6 days. Longer operative time (p=0.04), lower albumin (p<0.001), higher ASA score (p<0.001), no epidural use (p=0.04), and higher creatinine (p<0.001) all correlated positively with longer LOS. ASA score and creatinine were the strongest predictors of LOS. LOS was not affected by patient age, sex, diagnosis, presence of malignancy, intraoperative transfusion requirements, intraoperative hypotension, preoperative bilirubin, case volume per year or year of surgery. Conclusions. Liver resections can be performed with low mortality/morbidity and with acceptable LOS by an experienced liver surgeon. Outcome as measured by LOS is most influenced by patient comorbidities entering into surgery. Annual case volume did not influence LOS and had no impact on patient safety. Length of stay may not reflect surgeon/institution performance, as LOS is multifactorial and likely related to patient population, patient selection and increased high-risk cases with a surgeon's experience. [source] Indications for fetal echocardiography from a tertiary-care obstetric sonography practiceJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2004Lynn L. Simpson MD Abstract Purpose The present study was conducted to evaluate the indications for fetal echocardiography in a tertiary-care obstetric sonography practice and to determine the incidences of confirmed congenital heart disease for each primary indication. Methods A retrospective analysis of all pregnant women referred to a pediatric cardiology unit for fetal echocardiography by the tertiary-care sonography unit over a 2-year period was performed. The primary indications for referral for fetal echocardiography were obtained from the sonographers' reports. Outcome data were extracted from the fetal echocardiograms, postnatal echocardiograms or pathology and autopsy reports, and patient medical records. Results Of 6,002 pregnant women who had undergone prenatal sonographic examination during the study period, 275 (4.6%) had been subsequently referred for fetal echocardiography. The most common primary indication for referral had been abnormal cardiac findings on the prenatal sonographic examination, which had been present in 64 (23.3%) of the 275 cases. In 44 (69%) of those 64 cases, congenital heart disease had been confirmed. Among the 211 patients who had had normal cardiac findings on prenatal sonography but had been referred for fetal echocardiography owing to other primary indications, congenital heart disease had been confirmed in only 7 cases (3.3%). Conclusions An abnormal cardiac finding during prenatal sonographic examination is a common primary indication for fetal echocardiography and is more useful for identifying congenital heart disease than are other risk factors. Careful routine cardiac screening during routine prenatal sonographic examination may facilitate further investigation and treatment. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:123,128, 2004 [source] Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective techniqueJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2008Alessio Redaelli MD Summary Objective, The management of nasal deformities, and in particular those with "plunging" tip, has always been a typical area of interest in surgery. In the author's experience many of these problems can be successfully approached with a new medical technique, which consists of using only hyaluronic acid for the correction of nasal angles and botulinum toxin for patients with hyperactivity of the depressor septi nasi muscle. The present study aims to illustrate this new technique and evaluates safety and results. Materials and methods, Ninety-five patients were treated between January 2006 and July 2007. The average age of the patients was 42.7 years. In 45% of the cases, botulinum toxin was employed. In all of the cases, the treatment was conducted with hyaluronic acid (24 mg/mL), the same substance used for face rejuvenation. The amount varied from 0.6 to 1.4 mL. Results Results were evaluated using a definitive graduated score calculated by patient's and doctor's satisfaction score (range, 1,10) and by photographs' score at time 0, after 30 days, and after 180 days. It ranged from 8 to 10 (average of 9.1). No significant side effects were reported. Conclusion, The medical rhinoplasty for a "plunging" nose is a simple and very effective technique with immediate results. It can be used in those cases where patients are reluctant to undergo surgery, or as primary indication in the correction of minor nose defects. Results are satisfactory and no side effects have been reported so far. Results will last for a long time. [source] Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal painALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009K. THAKKAR Summary Background, Abdominal pain is the most common indication for oesophagogastroduodenoscopy (OGD) in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. Aim, To examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and to describe the endoscopic and histological findings in patients undergoing OGD for abdominal pain of unclear aetiology. Methods, We performed a retrospective cross-sectional cohort study in children under 18 years of age who had OGD for the primary indication of abdominal pain, at Texas Children's Hospital and Children's Hospital of The King's Daughters from 1 January 2002 to 30 June 2005. Results, Overall, OGD was diagnostic in 454 (38.1%) of the 1191 procedures, including reflux oesophagitis (23%, n = 271), Helicobacter pylori infections (5%, n = 55), peptic ulcers (3%, n = 32), eosinophilic oesophagitis (2%, n = 25), celiac disease (1%, n = 9) and Crohn's disease (0.5%, n = 7). Male gender, older age, elevated C-reactive protein and vomiting were associated with increased diagnostic yield. Conclusions, Our findings suggest that OGD is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%. The majority of alarm symptoms and routine laboratory tests are not significantly associated with diagnostic yield. [source] Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infectionLIVER TRANSPLANTATION, Issue 12 2004Guy W. Neff Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44%) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50% and 75% in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32% versus 17% in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue. (Liver Transpl 2004;10:1497,1503.) [source] Pain Processing: Paradoxes and PredictionsPAIN PRACTICE, Issue 1 2001William J. Martin PhD Abstract: During the last 25 years, there have been substantial advances in our understanding of the physiology and pathophysiology of pain. The development of animal models that more closely mimic clinical pain in humans has helped elucidate the putative mechanisms by which chronic pain develops and is maintained. However, our increased understanding of the neurobiology of pain has not translated into breakthrough treatments for pain management. As such, chronic pain is still primarily managed by drugs whose primary indication does not include pain (eg, antidepressants, anticonvulsants, antiarrhythmics, local anesthetics). These adjuvant analgesics have come into favor despite the fact that the mechanisms through which these drugs provide pain relief remain either largely unknown or are not selective for a single target. Moreover, the efficacy of adjuvant analgesics in animal models of pain is often validated only after case studies or clinical trials have been reported. This retrospective validation of "novel" analgesics in animal models of pain raises a question of the predictive validity of these models. This article reviews the use of several adjuvant and standard analgesics currently used to treat difficult-to-manage pain. What can these drugs teach us about the development of novel pain medicines? Within this context, the use of animal models of pain to predict analgesic efficacy in clinical pain conditions is considered. [source] Comparison of microarray-based detection rates for cytogenetic abnormalities in prenatal and neonatal specimensPRENATAL DIAGNOSIS, Issue 9 2008Lisa G. Shaffer Abstract Objective To compare the detection rate by microarray analysis for chromosome abnormalities in a prenatal population to that of a neonatal population referred for diagnostic testing. Methods Array comparative genomic hybridization (aCGH) analysis was performed for 151 prenatal cases and compared with the results from 1375 postnatal cases less than 3 months of age. Results Two of 151 prenatal cases (1.3%) showed a clinically significant cytogenetic abnormality. In contrast, of the 1375 postnatal cases studied, 11.4% showed a cytogenetic abnormality by aCGH. Many of these (40%) were referred for aCGH because of dysmorphic features, a clinical indication unlikely to be identified in the prenatal population. Conclusions The chance of detecting a chromosome abnormality in a prenatal population that has already been screened by routine cytogenetics is ,1.3%. However, given that many of the abnormal array results in the neonatal population were among those with dysmorphic features as the primary indication for testing, which are not easily identifiable by ultrasound, offering prenatal testing by aCGH to a wider population would likely result in a higher detection rate. Copyright © 2008 John Wiley & Sons, Ltd. [source] Indications for fetal echocardiography from a tertiary-care obstetric sonography practiceJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2004Lynn L. Simpson MD Abstract Purpose The present study was conducted to evaluate the indications for fetal echocardiography in a tertiary-care obstetric sonography practice and to determine the incidences of confirmed congenital heart disease for each primary indication. Methods A retrospective analysis of all pregnant women referred to a pediatric cardiology unit for fetal echocardiography by the tertiary-care sonography unit over a 2-year period was performed. The primary indications for referral for fetal echocardiography were obtained from the sonographers' reports. Outcome data were extracted from the fetal echocardiograms, postnatal echocardiograms or pathology and autopsy reports, and patient medical records. Results Of 6,002 pregnant women who had undergone prenatal sonographic examination during the study period, 275 (4.6%) had been subsequently referred for fetal echocardiography. The most common primary indication for referral had been abnormal cardiac findings on the prenatal sonographic examination, which had been present in 64 (23.3%) of the 275 cases. In 44 (69%) of those 64 cases, congenital heart disease had been confirmed. Among the 211 patients who had had normal cardiac findings on prenatal sonography but had been referred for fetal echocardiography owing to other primary indications, congenital heart disease had been confirmed in only 7 cases (3.3%). Conclusions An abnormal cardiac finding during prenatal sonographic examination is a common primary indication for fetal echocardiography and is more useful for identifying congenital heart disease than are other risk factors. Careful routine cardiac screening during routine prenatal sonographic examination may facilitate further investigation and treatment. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:123,128, 2004 [source] | ||||||||||