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From November (from + november)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010
H.-C. LAI
Background: Whether and how chronic advanced aortic regurgitation (AR) impacts the perioperative outcome of noncardiac surgery remains unclear. Methods: From November 1999 to December 2006, all patients undergoing noncardiac operations and ever examined by echocardiography within the last 6 months were screened. Those with chronic moderate,severe or severe AR were enrolled, provided they were not already trachea-intubated or aortic valve operated, and the surgery was not performed under local anesthesia. Case-matched subjects without significant AR served as controls. The perioperative outcomes of these patients were analyzed, and independent prognostic correlates were investigated by multivariate logistic regression analysis. Results: A total of 167 patients (male 131, mean age of 75 years) complying with the enrollment criteria were studied. Compared with the other 167 case-matched control peers, patients with advanced AR risked potential hazards of serious hemodynamic instability (0.6%) and circulatory collapse (1.2%) during surgery despite the similar incidence of overall cardiac adverse events, and were further distressed with more cardiopulmonary complications (16.2% vs. 5.4%, P=0.003) and in-hospital deaths (9% vs. 1.8%, P=0.008) post-operatively. Multivariate regression analysis confirmed the correlation of advanced AR with perioperative mortality, and identified depressed left ventricular function, renal dysfunction, high surgical risk, and lack of cardiac medication as predictors of in-hospital death. Conclusion: Chronic advanced AR complicates the perioperative outcome of noncardiac surgery as reflected by frequent cardiopulmonary morbidities and in-hospital deaths, especially when coexisting with specified high-risk clinical and surgical characteristics. [source]

Repair of Partial Atrioventricular Septal Defect Through a Minimal Right Vertical Infra-Axillary Thoracotomy

JOURNAL OF CARDIAC SURGERY, Issue 3 2002
Xiubin Yang M.D.
Methods: From November 1997 to January 2000, six patients with a mean age of 19.2 ± 7.7 years underwent minimal right vertical infraaxillary thoracotomy (VIAT) for PAVSD repair. Left atrioventricular (AV) valve regurgitation was tested on the beating heart before and after valvuloplasty. Commissuroplasty of the left AV valve and atrial septum repair were done in all patients. Results: There was no operative or late mortality, and no morbidity directly related to the thoracotomy approach. The average length of the incision was 8.3 ± 1.3 cm. The arrest times averaged 32.8 ± 8.3 minutes, and the cardiopulmonary bypass times averaged 66.0 ± 9.0 minutes. One patient had mild-to-moderate left AV valve regurgitation postoperatively. All patients were free of symptoms during follow-up. Conclusion: Minimal right VIAT is a safe, more cosmetic, and less invasive approach than median sternotomy for the repair of PAVSD. [source]

Pain-determined Dissociation Episodes

PAIN MEDICINE, Issue 3 2001
David A. Fishbain MD, FAPA
Objectives., Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or perception. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue ( DF) and dissociative identity disorder ( DID), in patients with chronic pain ( PWCP). Design/Patients/Interventions/Outcome Measures.,From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP evaluated and/or treated at the University of Miami Comprehensive Pain and Rehabilitation Center. The salient features of these six dissociation PWCP are presented. All four DF PWCP completed a dissociation experience scale first at the time of identification of the dissociation disorder (with chronic pain) and one alleging their experiences with dissociation predevelopment of chronic pain. Results., Frequency percentage for dissociation for this population was 0.235%. For all four of the DF PWCP, dissociation episodes began after the onset of chronic pain. All six (100%) PWCP described or associated their episodes of dissociation to times when their pain would increase. Mean dissociation scale scores for the four DF PWCP were 1.4 ± 1.11 pre-chronic pain and 20.53 ± 16.82 at time of identification of the dissociative disorder (with chronic pain). Conclusions., The frequency percentage for dissociation within PWCP is small compared with psychiatric populations. There may be an etiological association between the development of dissociation episodes and the development of chronic pain and/or increases in chronic pain. [source]

Adult and Pediatric Emergency Department Sexually Transmitted Disease and HIV Screening: Programmatic Overview and Outcomes

ACADEMIC EMERGENCY MEDICINE, Issue 3 2007
Supriya D. Mehta PhD
Objectives: To measure the prevalence of gonorrhea, chlamydia, and human immunodeficiency virus (HIV) infection among emergency department (ED) patients who accept screening, and to assess treatment outcomes and risks for infection. Methods: Research staff offered voluntary testing for gonorrhea and chlamydia (by urine transcription-mediated amplification) and HIV (by enzyme immunoassay/Western blot of oral mucosal transudate) to ED patients. Pediatric (15,21 years) and adult (22,29 years) patients were eligible for gonorrhea and chlamydia testing; patients aged 15,54 years were eligible for HIV testing. The authors surveyed behavioral risks of patients accepting HIV testing. Results: From November 2003 to May 2004, 497 of 791 eligible pediatric patients (63%) and 1,000 of 2,180 eligible adult patients (46%) accepted screening for gonorrhea, chlamydia, and/or HIV. There were 41 patients infected with gonorrhea, chlamydia, or both among 380 pediatric patients (10.8%) and 11 of 233 adult patients (4.7%); 14 of 52 patients (27%) were treated presumptively by ED clinicians. Through study efforts, 33 of the 38 remaining patients were treated (90% overall treatment). Eight HIV infections were diagnosed: seven of 969 adult patients (0.7%) and one of 459 pediatric patients (0.2%); five HIV-infected patients (63%) received test results, and three (38%) attended an HIV clinic. Gonorrhea or chlamydia infection in pediatric patients was associated with multiple sex partners, same-sex intercourse, and suspicion of sexually transmitted diseases by the ED clinician. Conclusions: The high prevalence of gonorrhea and/or chlamydia infection among pediatric ED patients tested supports consideration of expanded screening. Targeted HIV screening with rapid tests merits exploration in the authors' ED, given the low-moderate numbers of patients identified through screening, receiving test results, and linked to care. [source]