Home About us Contact
|
Home About us Contact | ||
|
|
||
Clinical Experience (clinical + experience)
Kinds of Clinical Experience Selected AbstractsBalloon Debanding the Pulmonary Artery: In Vitro Studies and Early Clinical ExperienceCONGENITAL HEART DISEASE, Issue 4 2009Gareth J. Morgan MPhil ABSTRACT Despite increasing corrective procedures for children with congenital heart disease, there remains a place for surgical banding of the main pulmonary artery (PA). In the vast majority of cases, these bands eventually need to be removed. We examined three cases of percutaneous disruption of PA bands using balloon catheters at our institution. We also performed an in vitro study of PA band disruption mechanism and disruption pressure. Our in vitro study suggested a predictable burst pressure for PA bands over the range of diameters routinely used in pediatric practice. Of three patients who underwent interventional debanding, two patients had successful disruption of their PA bands with no reintervention at 19 months and 23 months follow up. Balloon disruption of surgical PA bands may offer a less invasive alternative to surgical band removal. In vitro analysis suggests that the burst pressure required and mechanism of disruption are predictable. [source] Current Treatment of Myoclonic Astatic Epilepsy: Clinical Experience at the Children's Hospital of PhiladelphiaEPILEPSIA, Issue 9 2007Sudha Kilaru Summary:,Purpose: Myoclonic astatic epilepsy (MAE) is a generalized epilepsy of early childhood. Little is known about the use of newer antiepileptic treatments (AET) in MAE. The purpose of this study was to describe the characteristics, treatment, and outcome of a contemporary MAE cohort exposed to the new generation AET. Methods: Charts of subjects with MAE treated between 1998 and 2005 were reviewed. Results: Twenty-three subjects (19 boys), with a median (range) follow-up of 38 (2, 86) months were identified. Thirty-nine percent had a family history of epilepsy, and 39% had family history of febrile seizures. Age at seizure onset was a median of 36 (12,24) months. Initial EEG was normal in 30%. When seizures ceased, EEG background and epileptiform abnormalities persisted in 17 and 58%, respectively. On average, each subject was exposed to five AET. The most frequently used AET was valproate (83%). Seizure freedom occurred spontaneously in three subjects, with ethosuximide and levetiracetam in one each, valproate and lamotrigine in two each, topiramate in three and the ketogenic diet (KD) in five subjects. By 36 months after seizure onset, 67% achieved seizure freedom. At the last visit, 43% were developmentally normal, 52% had mild, and 5% had moderate cognitive disabilities. Time to seizure freedom did not correlate with cognitive outcome. Conclusions: The new generation of AET may offer significant benefit to children with MAE. The KD was the most effective AET in this series, and perhaps should be considered earlier in treatment. [source] General Anesthesia and the Ketogenic Diet: Clinical Experience in Nine PatientsEPILEPSIA, Issue 5 2002Ignacio Valencia Summary: ,Purpose: To determine if children actively on the ketogenic diet (KD) can safely undergo general anesthesia (GA) for surgical procedures. Methods: The records of children treated with the KD at Children's Hospital (Boston, Massachusetts) from 1995 to the present were reviewed. The charts of children who had received GA while on the diet were evaluated with regard to demographics, procedure information, anesthesia records, blood chemistries, and perioperative course. Of 71 children on the KD during the period of the study, nine (12.7%) had procedures requiring GA while on the diet. Results: Nine children received GA for surgical procedures ranging from central line placement to hemispherectomy while on the KD. At the time of GA, the children ranged from age 1 to 6 years, and had been on the KD for 2,60 months. The patients received carbohydrate-free intravenous solutions perioperatively. Anesthesia duration ranged from 20 min to 11.5 h; for longer procedures, serum pH, glucose, and electrolyte levels were monitored. Serum glucose levels remained stable in all patients, but serum pH typically decreased; the largest reduction was to 7.16. In three procedures, patients received intravenous bicarbonate because of level of acidosis. There were no perioperative complications. Conclusions: Children on the KD can safely undergo GA for surgical procedures. Although serum glucose levels appear to remain stable, serum pH or bicarbonate levels should be monitored because of the risk of metabolic acidosis. [source] The Novacor Left Ventricular Assist System: Clinical Experience from the Novacor RegistryJOURNAL OF CARDIAC SURGERY, Issue 4 2001F. Dagenais The electrically powered Novacor left ventricular assist (LVAS) system was first used clinically as a bridge to transplant in 1984. The configuration has evolved to the current wearable model used clinically for the first time in 1993. In 1998, the inflow conduit was modified, reducing embolic events by 50%. Over 1100 implants have been performed worldwide with cumulative support greater than 300 patient years, and only 0.7% requiring replacement. The Novacor is a safe and effective device for bridge to transplant, bridge to recovery, or potentially permanent implant with reliable long-term support for periods long as 4 years. [source] Clinical Experience with a Single Catheter for Mapping and Ablation of Pulmonary Vein OstiumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009PAOLO DE FILIPPO M.D. Introduction: The aim of this single center study is to evaluate the safety and the efficacy of performing pulmonary vein isolation (PVI) using a single high-density mesh ablator (HDMA) catheter. Methods: A total of 17 consecutive patients with paroxysmal (10 patients) or persistent atrial fibrillation (7 patients) and no heart disease were enrolled. A single transseptal puncture was performed and the HDMA was placed at each PV ostium identified with anatomic and electrophysiological mapping. Pulsed radiofrequency (RF) energy was delivered at the targeted temperature of 58°C with maximum power of 80 watts. No other ablation system was utilized. The primary objective of the study was acute isolation of the targeted PV, and the secondary objective was clinical efficacy and safety of PVI with HDMA for atrial fibrillation (AF) prevention. Patients were followed at intervals of 1, 3, 6, and 12 months. Results: PVI was attempted with HDMA in 67/67 PVs. [Correction made after online publication October 27, 2008: PVs changed from 6/67 to 67/67] Acute success rate were: 100% (16/16) for left superior PV, 100% (16/16) for left inferior PV, 100% (17/17) for right superior PV, 100% (1/1) for left common trunk and 47% (8/17) for right inferior PV. Total procedure time was 200 ± 36 minutes (range 130,240 minutes) and total fluoroscopy time was 42 ± 18 minutes (range 23,75 minutes). During a mean follow-up of 11 ± 4 months, 64% of patients remained in sinus rhythm (8/10 paroxysmal AF and 3/7 for persistent AF). No complications occurred either acutely or at follow-up. Conclusions: PV isolation with HDMA is feasible and safe. The midterm efficacy in maintaining sinus rhythm is higher in paroxysmal than in persistent patients. [source] Initial Clinical Experience with Cardiac Resynchronization Therapy Utilizing a Magnetic Navigation SystemJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007PETER GALLAGHER M.D. Introduction: The placement of left ventricular (LV) leads during cardiac resynchronization therapy (CRT) involves many technical difficulties. These difficulties increase procedural times and decrease procedural success rates. Methods and Results: A total of 50 patients with severe cardiomyopathy (mean LV ejection fraction was 21 ± 6%) and a wide QRS underwent CRT implantation. Magnetic navigation (Stereotaxis, Inc.) was used to position a magnet-tipped 0.014, guidewire (CronusÔ guidewire) within the coronary sinus (CS) vasculature. LV leads were placed in a lateral CS branch, either using a standard CS delivery sheath or using a "bare-wire" approach without a CS delivery sheath. The mean total procedure time was 98.1 ± 29.1 minutes with a mean fluoroscopy time of 22.7 ± 15.1 minutes. The mean LV lead positioning time was 10.4 ± 7.6 minutes. The use of a delivery sheath was associated with longer procedure times 98 ± 32 minutes vs 80 ± 18 minutes (P = 0.029), fluoroscopy times 23 ± 15 minutes vs 13 ± 4 minutes (P = 0.0007) and LV lead positioning times 10 ± 6 minutes vs 4 ± 2 minutes (P = 0.015) when compared to a "bare-wire" approach. When compared with 52 nonmagnetic-assisted control CRT cases, magnetic navigation reduced total LV lead positioning times (10.4 ± 7.6 minutes vs 18.6 ± 18.9 minutes; P = 0.005). If more than one CS branch vessel was tested, magnetic navigation was associated with significantly shorter times for LV lead placement (16.2 ± 7.7 minutes vs 36.4 ± 23.4 minutes; P = 0.004). Conclusions: Magnetic navigation is a safe, feasible, and efficient tool for lateral LV lead placement during CRT. Magnetic navigation during CRT allows for control of the tip direction of the CronusÔ 0.014, guidewire using either a standard CS delivery sheath or "bare-wire" approach. Although there are some important limitations to the 0.014, CronusÔ magnetic navigation can decrease LV lead placement times compared with nonmagnetic-assisted control CRT cases, particularly if multiple CS branches are to be tested. [source] Clinical Experience with a Novel Intracoronary Perfusion Catheter to Treat No-Reflow Phenomenon in Acute Coronary SyndromesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2010GABRIEL MALUENDA M.D. Background:,The no-reflow phenomenon is an often seen complication in patients presenting with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This event is associated with poor prognosis and poses a therapeutic challenge. Methods:,This retrospective study cohort was composed of 30 patients who presented with ACS between September 2007 and April 2009, and developed no-reflow during subsequent PCI. The primary end-point was defined as normal Thrombolysis In Myocardial Infarction (TIMI) 3 flow with myocardial blush grade (MBG) ,2 or an increase in TIMI flow by ,2 grades with a MBG ,2 after intracoronary drug infusion via the ClearWay (CW) RX perfusion catheter. Results:,The population presented with a relatively high prevalence of cardiovascular risk factors. ST-elevation myocardial infarction was the most common presentation (60.0%), while 20% of the patients presented with cardiogenic shock. After intracoronary infusion of nicardipine or nitroprusside using the CW catheter, TIMI flow improved from the baseline in 19 cases (63.3%, P < 0.001), and 16 patients (53.3%, P < 0.001) achieved normal coronary flow at the end of the procedure. The rate of in-hospital death was 6.7% (2 cases). No clinical differences were noted between those patients who successfully achieved normal coronary flow and those with persistent no-reflow. Conclusion:,The infusion of intracoronary drugs using the novel perfusion CW RX catheter seems to be safe and could help to improve myocardial perfusion in a selected group of patients presenting with ACS who developed no-reflow during PCI. (J Interven Cardiol 2010;23:109-113) [source] Clinical Experience with Trastuzumab (Herceptin)THE BREAST JOURNAL, Issue 6 2003Charles L. Vogel MD Abstract: Trastuzumab is a humanized monoclonal antibody against the epidermal growth factor family oncogene, Her-2/neu. It has revolutionized therapy for the 15,20% of patients with metastatic breast cancer whose tumors have gene amplification for Her-2/neu. Results of clinical trials with single agent trastuzumab and in combination with paclitaxel, docetaxel, vinorelbine, gemcitabine and platinum salts have been encouraging. Durable remissions in excess of 5 years have occasionally been reported. Subjectively the side effect profile of this novel, targeted therapy, has been mild. Cardiac toxicity, while reported in combination regimens with anthracyclines tend to be easily manageable and not absolute contradictions to continuation of trastuzumab. Outside of clinical trials, however, anthracycline/trastuzumab combinations should be avoided. Preliminary results of trials with various combinations of chemotherapeutic agents have been promising while combinations with hormonal and other biologic therapy are ongoing. Trastuzumab is an exciting new monoclonal antibody with interesting anti-tumor activity in patients with Her-2/neu gene amplified breast cancer. We look forward to ongoing clinical trials combining trastuzumab with a broad array of other chemotherapeutic, hormonal and biological agents. [source] Audiological Application Criteria for Implantable Hearing Aid Devices: A Clinical Experience at the Nijmegen ORL Clinic,THE LARYNGOSCOPE, Issue 9 2008Veronique J. O. Verhaegen MD Abstract Objectives/Hypothesis: To define audiological application criteria for different implantable hearing aid devices. Study Design: Retrospective study. Methods: Comparisons were made between aided speech recognition scores obtained at conversational level (65 dB) in patients with the Vibrant Soundbridge (VSB) (n = 22), the Otologics middle ear transducer (MET) (n = 10), conventional hearing aids (behind-the-ears) (n = 47), and cochlear implants (CIs) (n = 123). Results: In relation to hearing loss, only for mild hearing loss, speech recognition scores with VSB were comparable to that with conventional hearing aids. In the Otologics MET users, speech recognition scores were comparable with those of the conventional hearing aid users until a mean hearing loss of about 75 dB HL. At a sensorineural hearing loss of about 65 dB HL or more, the Otologics MET users have better speech recognition scores than the VSB users. For comparison with CI users, we followed a more conservative approach. In 90% of the users of a CI, speech recognition scores were better than those in: 1) patients with a conventional hearing aid and a mean hearing loss of about 95 dB HL or worse; 2) patients with an Otologics MET and a mean hearing loss of 85 dB HL or worse. Conclusions: Patients fitted with a VSB or an Otologics MET middle ear implant do not demonstrate better speech recognition scores than patients fitted with today's conventional hearing aids. Results might even been worse. However, the VSB and Otologics MET are a good option in patients with moderate (VSB) to severe (Otologics MET) sensorineural hearing loss and external otitis. [source] Fascia Augmentation of the Vocal Fold: Graft Yield in the Canine and Preliminary Clinical Experience,THE LARYNGOSCOPE, Issue 5 2001Sanford G. Duke MD Abstract Introduction Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. Study Design A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. Methods Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. Results In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%,84%) compared with autologous lipoinjection (47%; range, 7%,96%;P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. Conclusions Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency. [source] Initial Clinical Experience With the HeartMate II Ventricular Assist System in a Pediatric InstitutionARTIFICIAL ORGANS, Issue 7 2010William R. Owens Abstract In many adult cardiac programs, intracorporeal mechanical circulatory support has become a routine treatment for end-stage cardiac failure. For the pediatric population, options are often limited by a small body habitus. Even when an adolescent's weight may suggest adequate space for device implant, most intracorporeal adult devices remain too large for adolescents. The Thoratec HeartMate II (HM II) (approved by the FDA in April of 2008) is a small, noiseless device that is easily operated and monitored. By having an uncomplicated operating system and small percutaneous drive line, the HM II provides an opportunity for these patients to aggressively rehabilitate to become a better transplant candidate and also provides the potential to be discharged home. The two youngest patients ever to utilize the HM II are also the first two cases of using the HM II at a freestanding pediatric hospital. A 12-year-old, 53 kg, girl with dilated cardiomyopathy was supported for 85 days before receiving her heart transplant. The second patient, a 13-year-old, 149 kg, Hispanic male suffering from morbid obesity and dilated cardiomyopathy, was supported for 128 days. The HM II allowed for rehabilitation and nutritional education, resulting in this patient losing 50 kg before heart transplant. Despite both of these patients' size, their thoracic cavities were that of a preadolescent and thus techniques were developed to avoid morbidities like chest wall abrasion and bleeding. Because of differences between adult and pediatric patients and institutions, these cases provided unique challenges. However, as pediatric device therapy is now maturing, pediatric programs such as Texas Children's Hospital have begun to develop strategies for mechanical support that factor in patient's size and need for long-term or temporary support, utilizing the growing number of devices (i.e., Jostra Rotoflow, Tandem Heart PTVA, Thoratec CentriMag, Berlin Heart EXCOR, etc.) that are now available to children. [source] First Clinical Experience With the Air Purge Control and Electrical Remote-controlled Tubing Clamp in Mini BypassARTIFICIAL ORGANS, Issue 9 2006Rien M.A.J.M. Huybregts Abstract:, Most mini bypass systems do not contain a venous and cardiotomy reservoir in the cardiopulmonary bypass (CPB) circuit and lack the capability to remove venous air. In conjunction with the manufacturer the air purge control system, a system which automatically removes air that is captured in a venous bubble trap, has been developed. This system is combined with an electrical remote clamp, which automatically clamps the arterial line in case air leaves the bubble trap. Twenty consecutive patients undergoing surgery with CPB were included in this clinical validation. Venous air was removed by the air purge control during bypass. The electrical remote clamp was never activated by the system, confirming that the air purge control adequately removed venous air during these cases. The air purge control, in conjunction with the electrical remote clamp, is a valuable safety feature in mini bypass, enhancing patient safety and user friendliness while providing a level of safety equivalent to those of conventional bypass systems. [source] Clinical Experience with Molecular Adsorbent Recirculating System (MARS) in Patients with Drug-induced Liver FailureARTIFICIAL ORGANS, Issue 5 2004Xin-min Zhou Abstract:, The molecular adsorbent recirculating system (MARS) is a novel extracorporeal technique for liver support. We report the clinical results in a group of fourteen patients with drug-induced liver failure. Fourteen patients, aged 22,83 years, with acute or subacute liver failure [mean Child,Turcotte,Pugh (CTP) score 11 (range 8,15)] due to the intake of various drugs (diet pill overdose,2; Chinese traditional medicine (CTM),4; antibiotic, paracetamol, tuberculostatic, or vasodilator abuse,8) were treated with one to seven sessions of MARS. Beneficial effects such as the improvement of encephalopathy and prothrombin activity, as well as a reduction of bilirubin and ammonia were recorded during MARS treatments. Thirteen out of fourteen patients survived the hospitalization (93%), and two of the discharged patients died during the follow-up of 6,12 months. The overall survival rate was about 79%. MARS therapy can contribute to the improved treatment of drug-induced liver failure patients. [source] Emergency Medicine Subinternship: Does a Standard Clinical Experience Improve Performance Outcomes?ACADEMIC EMERGENCY MEDICINE, Issue 1 2008Christopher J. Lampe MD Abstract Background:, The emergency medicine (EM) subinternship provides a varied experience for senior medical students depending on gender, specialty choice, and interest. A didactic curriculum can be standardized, but the clinical component is difficult to control. Students can be directed to see patients with specific chief complaints. Objectives:, To assess whether a clinical requirement of 10 predetermined cases improves general knowledge as measured on an objective exam. Methods:, This was a prospective, nonrandomized, case-controlled study at a public teaching hospital. Students were assigned to the control group (CG) or test group (TG) by alternating block rotations over 6 months. The CG saw emergency department (ED) patients according to interest and faculty direction. The TG was also required to identify ten specific chief complaints. Patient encounters were recorded in computerized logs. A 10-question pretest assessed preexisting knowledge of each chief complaint, and a 40-question final exam tested general EM knowledge. Descriptive statistics measured demographic data. Groups were compared by Fisher's exact test. Difference in means testing was performed to see if pre- to posttest differences varied by group. Multivariate analysis controlled for gender and specialty choice. Results:, Eighteen CG students saw a mean of 57 patients, and 24 TG students saw a mean of 54 patients; 1 CG student (6%) and 7 TG students (31.8%) saw all 10 required cases (Fisher's exact test p = 0.044). Difference in means testing demonstrated a greater relative change in performance (13.4% points) by the TG relative to the CG on a general knowledge exam, compared with their performance on a brief pretest (p = 0.014). The authors performed multivariate regression controlling for pretest score, gender, and EM specialty choice, and neither gender nor intended EM specialty choice was a contributing factor to the improved performance. A greater relative change in performance (7% points) in the TG exam score was found when compared to the CG (p = 0.020). Conclusions:, Students who participated in the usual didactic curriculum and were required to see ED patients with representative chief complaints performed better on a general EM exam than those who employed common methods of choosing patients. [source] Clinical Experience of TiUniteÔ Implants: A 5-year Cross-Sectional, Retrospective Follow-Up StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2010Bertil Friberg DDS ABSTRACT Background: Little is known of the long-term clinical and radiographic performance of moderately rough surface implants. Purpose: The aim of the present retrospective investigation was to study two pioneer cohorts of patients, that is, the first patients to receive Brånemark System® implants with a moderately rough surface (TiUniteÔ, Nobel Biocare AB, Göteborg, Sweden) at the present clinic. TiUnite implants were inserted either in compromised bone sites in a mixed-mouth concept together with turned implants or used solely. Patients were followed up over a period of 5 years with regard to implant survival and the marginal bone response. Materials and Methods: Patients who received both implant types (mixed group) comprised 41 subjects, and the second group (TiUnite group) comprised 70 subjects. A total of 110 turned and 68 TiUnite implants were placed in the mixed group, and 212 TiUnite implants in the TiUnite group. Follow-up radiographs were obtained at prosthesis placement and at the 1- and 5-year check-ups, and examined by independent observers. Results: One turned (0.9%) and two TiUnite (2.9%) implants failed in the mixed group, and three implants (1.6%) failed in the TiUnite group, indicating no significant differences between surfaces or groups (p < .05). The mean marginal bone loss at 5 years was 0.6 mm to 0.8 mm, also indicating no significant differences for the two implant types tested in the mixed group. Conclusions: Cumulative survival rates for the two implant surfaces were favorable at 5 years, and the marginal bone loss was low and similar for both implant surfaces. [source] Special Features: Education: Challenges and Opportunities Associated with Preceptored Community Health Clinical ExperiencesPUBLIC HEALTH NURSING, Issue 5 2010Gail H. Wade ABSTRACT Preceptored community experiences present challenges different from those of preceptored experiences in the acute care setting. Instead of focusing on psychomotor skills, faculty must address population-based skills and assess students' abilities to practice these skills. Faculty and preceptors' lack of knowledge to teach these skills further complicate the experiences, an issue indirectly related to faculty and nursing shortages. Although preceptors guide students, faculty are responsible for evaluating students in community preceptored experiences. The Association of Community Health Nursing Educators (ACHNE) Essentials of Baccalaureate Education (Essentials) offers opportunities for guiding and evaluating community health preceptored clinical experiences. Assignments and activities that reflect the ACHNE Essentials provide a firm foundation for the population focus of the course. This focus is validated through faculty visits to students in a variety of community settings. To plan successful community experiences and evaluate students, faculty must be knowledgeable about the population focus of community courses, apply this knowledge to students in a variety of settings, and ask challenging questions to assess student learning. [source] A Novel Femoral Arterial Cannula to Prevent Limb Ischemia During Cardiopulmonary Support: Preliminary Report of Experimental and Clinical ExperiencesARTIFICIAL ORGANS, Issue 7 2006Yoshiro Matsui Abstract:, Distal limb ischemia may occur as a serious complication related to the use of femoral cannulation during veno-arterial cardiopulmonary support (CPS). We developed a simple cannula for femoral arterial cannulation with two holes in the side wall, which could provide the distal limb blood flow without additional cannulation or surgical procedure. This cannula can be inserted into the femoral artery by routine Seldinger technique. The distal blood flow from the side holes can be confirmed by Doppler detector without specialized techniques. In porcine experimental model, the distance between the position where the blood flow was first detected and those where the blood leakage took place was at least more than 10 mm. When this cannula and its side holes were adequately positioned, the mean distal limb flow ranged from 75 to 90 mL/min under CPS at a flow of 1.5 L/min. We employed this cannula for six patients in clinical settings. Three patients showed a good distal limb blood flow at the introduction position without its adjustment. The other three patients showed distal limb ischemia at the introduction position, but the limb ischemia was soon recovered after a slight adjustment of its position. There was no blood leakage from the percutaneous entry into the artery in all cases. We currently use this cannula as the first choice for patients undergoing a prolonged CPS. [source] Clinical Experiences of Computer Numeric Control-Milled Titanium Frameworks Supported by Implants in the Edentulous Jaw: A 5-Year Prospective StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2004Anders Örtorp DDS ABSTRACT Background: Few long-term follow-up studies on treatment concepts using computer numeric control-milled titanium frameworks have been conducted. Objective: To evaluate the clinical and radiographic performance of implant-supported prostheses provided with computer numeric control-milled titanium frameworks in the edentulous jaw and to compare their performance during the first 5 years of function with that of prostheses provided with conventional cast gold alloy frameworks. Materials and Methods: A consecutive group of 126 edentulous patients were randomly provided with 67 prostheses with titanium frameworks (test group) in 23 upper jaws and 44 lower jaws and with 62 conventional prostheses with gold alloy castings (control group) in 31 upper jaws and 31 lower jaws. Clinical and radiographic 5-year data were collected for the test and control groups. Results: The frequency of problems was low, and clinical and radiologic performances were similar in both groups. In the test group, the 5-year cumulative survival rates (CSRs) were 94.9% and 98.3% for implants and titanium prostheses, respectively. The respective corresponding CSRs for the control group were 97.9% and 98.2%. More loaded implants were lost in the maxillas in the test group (p < .01), but this difference was not significant on the patient/prosthesis level (p > .05). Smokers lost more implants than nonsmokers lost (p < .01). Similar survival rates were observed for implants in the mandible. One prosthesis was lost in each group because of the loss of implants. Metal fractures were seen only in the control group, and resin veneer fractures were more frequent in the maxilla in the gold alloy group (p < .05). In the test group, the mean marginal bone loss was 0.5 mm (SD, 0.44) in the maxilla and 0.4 mm (SD, 0.50) in the mandible. A similar pattern of bone reaction was observed in the control group. Mean marginal bone loss was similar for smokers and nonsmokers (p > .05). Conclusion: Computer numeric control-milled titanium frameworks are a viable alternative to gold alloy castings in the edentulous jaw and present clinical and radiologic performances similar to those of conventional gold alloy frameworks during the first 5 years of function. [source] Clinical Experiences of CNC-Milled Titanium Frameworks Supported by Implants in the Edentulous Jaw: 1-Year Prospective StudyCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2000Anders Örtorp LDS ABSTRACT Background: A new type of titanium framework has been introduced, but so far no clinical reports have been made in this treatment modality. Purpose: The aim of this study was to report the clinical performance of implant-supported prostheses with computer numeric controlled (CNC)-milled titanium frameworks in the edentulous jaw and to compare the results with prostheses provided with conventional cast frameworks during the first year of function. Material and Methods: A consecutive group of 65 patients with 67 prostheses were provided with CNC-milled titanium frameworks in 23 upper and 44 lower jaws. During the same period, 61 consecutive patients were treated on a routine basis with 31 upper and 31 lower conventional gold alloy casting prostheses. Clinical and radiographic 1-year data were collected for both the test and control groups. Results: A total of 14 of 729 inserted implants were lost during the follow-up period (1.9%). All prostheses were functioning after 1 year except a conventional prosthesis with a cast framework, which was replaced by an implant-supported over-denture due to implant loss. The 1-year cumulative survival rate (CSR) was 100% and 97.8% for CNC prostheses and implants, respectively. The corresponding CSR for the control group was 98.3% and 98.3%, respectively. Few problems were reported in both groups, and the clinical and the radiologic performances were similar for both groups. No mechanical complications except some resin veneer fractures (n = 6) were observed. The mean marginal bone loss for the test group during the first year in function was 0.4 mm (SD = 0.35) and 0.4 mm (SD = 0.33) in the upper and lower jaws, respectively. A similar pattern of bone reaction was also observed in the control group. Conclusion: CNC-milled titanium frameworks can be used as an alternative to conventional castings in the edentulous jaw, presenting similar clinical and radiologic performances as conventional cast frameworks during the first year of function. [source] Prevalence and implications of psychopathological non-cognitive symptoms in dementiaACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009P. Saz Objective:, Clinical experience and recent population studies suggest that psychopathological, non-cognitive symptoms are both frequent and relevant in dementia. Method:, A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two-phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM-IV-TR criteria. Results:, The prevalence of non-cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative-type symptoms were most frequently found. A GMS ,apathy-related symptom cluster' (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non-cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer's type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed. Conclusion:, Non-cognitive, negative-type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non-cases, and might change current concepts of dementia. [source] Clinical experience with therapeutic hypothermia in asphyxiated infantsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2001Andrew Whitelaw No abstract is available for this article. [source] Outcome of sinonasal melanoma: Clinical experience and review of the literature,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2010Thomas N. Roth MD Abstract Background. Primary sinonasal malignant melanoma (SNMM) is a rare clinical entity. There is neither a classification nor a staging system nor an evidence-based treatment concept established. Our objective was to find potential risk factors predicting the outcome. Methods. Twenty-five patients with histologically confirmed SNMM were consecutively included and retrospectively analyzed. Staging methods were nasal endoscopy, CT, MRI, and positron emission tomography (PET) scan. Patients were selected for a curative or palliative concept. All patients had postoperative follow-up with control-MRI at 3 and 6 months. Restaging was performed when local recurrence occurred. Results. Nineteen patients underwent primary surgery with curative intention; in 16 cases with tumor free margins. Thirteen patients (68%) had transnasal endoscopic surgery, 4 lateral rhinotomy, and 2 transfacial approach with orbital exenteration. Six patients (32%) had palliative therapy and 7 patients (37%) had adjuvant radiotherapy. Despite radical operations, 6 patients (37%) showed local recurrence and 8 patients (50%) developed distant metastasis. In 2 patients with incomplete surgery, regional metastasis was noted. The median disease-free interval was 18 months, and the median overall survival rate was 23 months. Conclusion. SNMMs of the ethmoid and maxillary sinuses have a worse prognosis than other localizations in the nasal cavity; infiltration into the skull base, orbit, or facial soft tissue correlates with a very poor outcome corresponding to the palliative situations. Furthermore, local recurrence insinuates aggressive disease with short survival rate. A main difference from its cutaneous counterpart seems to be a primary tendency to hematogenic spread. Further research is needed to confirm these findings. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [source] Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experienceHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003Giuseppe Spriano MD Abstract Background. In head and neck cancer, the best prophylactic treatment for the N0 neck is a subject of debate. Some authors propose lateral selective lymph node dissection (levels II,IV) on the basis of the probability of finding occult metastases in those lymph nodes. A more extensive procedure including Vth level is considered unnecessary because of the low incidence of metastases in the posterior triangle. Methods. We retrospectively evaluated 346 N0 patients affected by laryngeal carcinoma and consecutively treated at the Department of Otorhinolaryngology of the Ospedale di Circolo, Varese, Italy. The patients underwent elective selective neck dissection (levels II,V) for a total of 602 dissected heminecks. Result. Seventy heminecks (11.6%) were pN+, and in 10 of 70 cases (14.3%) level V was involved; in 5 of 10 metastases were isolated. Conclusion. Our retrospective study confirms the probabilistic criteria of the incidence of occult metastasis by level in laryngeal cancer. On the basis of our data Vth level nodes, although very rarely, 10 of 604 (1.6%), are involved with laryngeal cancer. Our approach to routinely dissect Vth level nodes is discussed. © 2003 Wiley Periodicals, Inc. Head Neck 25: 97,102, 2003 [source] Service provision for elderly depressed persons and political and professional awareness for this subject: a comparison of six European countriesINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2003Anke Bramesfeld Abstract Objective Under-treatment of depression in late-life is a subject of rising public health concern throughout Europe. This study investigates and compares the availability of services for depressed elderly persons in Denmark, France, Germany, Sweden, Switzerland and the UK. Additionally, it explores factors that might contribute to an adequate services supply for depressed elderly people. Method Review of the literature and guide supported expert interviews. Analysis of the practice of care provision for depressed elderly persons and of indicators for political and professional awareness, such as university chairs, certification processes and political programmes in gerontopsychiatry. Results Only Switzerland and the UK offer countrywide community-oriented services for depressed elderly persons. Clinical experience in treating depression in late-life is not regularly acquired in the vocational training of the concerned professionals. Indicators suggest that the ,medical society' and health politics in Switzerland and the UK regard psychiatric disease in the elderly more importantly than it is the case in the other investigated countries. Conclusions Service provision for depressed elderly persons seems to be more elaborated and better available in countries where gerontopsychiatry is institutionalised to a greater extend in the ,medical society' and health politics. Copyright © 2003 John Wiley & Sons, Ltd. [source] Experienced and Less-Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical ThinkingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2003Catherine G. Ferrario DNSc PURPOSE. To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (,5 years' experience) and novice (<5 years' experience) emergency nurses. METHODS. Clinical simulations were completed by a nationwide randomly selected sample of 173 experienced and 46 less-experienced emergency nurses (N =229). FINDINGS. Experienced nurses used the heuristic, Judging by Causal Systems (diagnostic inferences deduced from systems of causal factors) significantly more did than less-experienced nurses. PRACTICE IMPLICATIONS. Standardized nursing diagnoses may cut short the time needed to develop representational thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote students' cognitive development through strategies that promote active, reflective, and integrative learning. Search terms: Clinical experience, diagnostic reasoning [source] Clinical experience with tumor necrosis factor blockers in Korean rheumatoid arthritis patientsINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2006Jin-Wuk HUR Abstract Tumor necrosis factor (TNF) blockers have become an important treatment in rheumatoid arthritis (RA) with its proven effectiveness. But it is not universally effective in all patients and it comes with a relatively high economic burden. We should use them effectively. Advances in pharmacoeconomics and pharmacogenetics may be able to help us reach this goal. This article will review our clinical experience of biological agents to treat RA at Hanyang University in Korea, with emphasis on the current therapies targeting TNF and the rational use of theses agents in RA. [source] Clinical experience with infliximab among Filipino patients with rheumatic diseasesINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2006Sandra V. NAVARRA Abstract Aim:, To describe the clinical experience with infliximab among Filipino patients with rheumatic diseases, specifically disease indications, dose regimens, clinical response, and adverse events. Methods:, We reviewed the data on Filipino patients who were given infliximab by rheumatologists for a rheumatic disease indication. The case report form included demographic profile, underlying rheumatic disease, comorbidities, concurrent medications, dose and frequency of infliximab, physicians' assessment of clinical response, and adverse events. The frequency of doses, intervals between doses, and discontinuation status were recorded. Results:, Included were 64 patients (35 females), with a mean age of 44 years. Most (41%) had rheumatoid arthritis, followed by psoriasis/psoriatic arthritis (31.2%) and ankylosing spondylitis (17.2%). Average disease duration from diagnosis to initiation of infliximab therapy was 7.6 years ± 6.7 SD. Among 35 patients, the interval between maintenance infusions ranged from 6 to 13.6 weeks, with a mean of 8.27 weeks. Clinical response was good to excellent in more than 80% of patients. Discontinuation rate was 10.9% and 28.1% at 3 and 12 months, respectively. Infusion-related adverse events were mild and transient, and 14 (21.8%) cases of infection resolved with appropriate therapy. Infliximab was temporarily withheld in five (7.8%) patients with active tuberculosis. Summary:, These findings substantiate the superior clinical efficacy of infliximab and manageable adverse events among Filipinos with rheumatic diseases. It also demonstrates dose regimens in clinical practice in a third world setting with limited resources. [source] BK virus nephropathy: Clinical experience in a university hospital in JapanINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2009Tatsuya Takayama Objectives: To review the medical records of patients with BK virus nephropathy (BKVN) following kidney transplantation in our institution. Methods: We screened patients for decoy cells using urine cytology, assessed serum creatinine levels, and conducted a graft biopsy, as well as assessed the presence of plasma BK virus DNA by quantitative real-time polymerase chain reaction. The treatment of BKVN was based on the decreased use of immunosuppressants. Results: Overall, six male patients were studied (mean age 40.8 years, range 18,58; mean donor age 45.2 years, range 15,67). A positive urine cytology screen led to the subsequent detection of plasma BK virus DNA in the five patients with urine cytology results positive for decoy cells. In the four patients in whom plasma BK virus DNA was detected, a maximum value of DNA of ,10 000 copies/mL was observed. Time elapsed from transplantation to BKVN diagnosis ranged from 3 to 62 months. Although the two cadaver grafts were lost, the loss was not due to any effects directly associated with BKVN. The other four grafts are still functioning with a mean creatinine level of 1.8 mg/dL. Most of the patients with BKVN were regarded as being in a state of heightened immunosuppression. BK virus transition to blood was prevented in one patient. Conclusions: Early diagnosis of BKV infection with reduction of immunosuppression may potentially counter BK viremia and retard progression of BKV nephropathy. Decoy cell screening by urine cytology as well as plasma BK virus DNA screening should be considered in addition to the required graft biopsy in kidney transplant recipients, particularly in those with impaired graft function. [source] Clinical experience of hormone therapy to bone metastatic prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2006MASAMI WAKISAKA Background:, A novel hormone therapy was instituted against prostate cancer with bone metastases and its therapeutic efficacy was investigated. Methods:, A total of 35 patients who had been pathologically diagnosed with carcinoma of the prostate between January 1994 and December 2003 were entered into the present study. Patients aged over 80 years were excluded from the study. As for the treatment methodology, diethylstilbestrol diphosphate (DES-P) at 500 mg/day was intravenously injected for 20,40 days, followed by monotherapy with an analog of luteinizing hormone-releasing hormone (LHRH). In all subjects, surgical castration was not conducted. The survival rate was analysed according to the method of Kaplan,Meier. Results:, One of the 35 patients was excluded from the study as this patient did not meet the inclusion criteria. There were four patients who dropped out of the study. On histology, 17 patients had moderately differentiated adenocarcinomas and 17 patients had poorly differentiated adenocarcinomas. As for the extent of disease (EOD), the patients were classified as with a score of 1 in 10 patients, 2 in 13 patients, 3 in 7 patients and 4 in 4 patients. The 5-year progression-free survival rate and overall survival rate were 24.3% and 60.6%, respectively. Conclusion:, Our new hormone therapy in the management of prostate cancer metastatic to the bone has demonstrated markedly superior therapeutic results compared to those so far obtained. [source] In vitro oxime protection of human red blood cell acetylcholinesterase inhibited by diisopropyl-fluorophosphateJOURNAL OF APPLIED TOXICOLOGY, Issue 4 2008D. E. Lorke Abstract Oximes are enzyme reactivators used in treating poisoning with organophosphorus cholinesterase (AChE) inhibitors. The oxime dose which can be safely administered is limited by the intrinsic toxicity of the substances such as their own AChE-inhibiting tendency. Clinical experience with the available oximes is disappointing. To meet this need, new AChE reactivators of potential clinical utility have been developed. The purpose of the study was to estimate in vitro both the intrinsic toxicity and the extent of possible protection conferred by established (pralidoxime, obidoxime, HI-6, methoxime, trimedoxime) and experimental (K-type) oximes, using diisopropyl-fluoro-phosphate (DFP) as an AChE inhibitor. The IC50 of DFP against human red blood cell AChE was determined (,120 nm). Measurements were then repeated in the presence of increasing oxime concentrations, leading to an apparent increase in DFP IC50. Calculated IC50 values were plotted against oxime concentrations to obtain an IC50 shift curve. The slope of this shift curve (tan,) was used to quantify the magnitude of the protective effect (nm IC50 increase per µm oxime). We show that, in the case of a linear relationship between oxime concentration and IC50, the binding constant K, determined using the Schild equation, equals IC50/DFP/tan,. Based on the values of tan, and of the binding constant K, some of the new K-oxime reactivators are far superior to pralidoxime (tan, = 0.8), obidoxime (1.5), HI-6 (0.8), trimedoxime (2.9) and methoxime (5.9), with K-107 (17), K-108 (20), and K-113 (16) being the outstanding compounds. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||||||||