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II Patients (ii + patient)
Kinds of II Patients Selected AbstractsInteraction of Implantable Defibrillator Therapy with Angiotensin-Converting Enzyme Deletion/Insertion PolymorphismJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2004MANINDER S. BEDI M.D. Introduction: The angiotensin-converting enzyme deletion allele (ACE D) decreases survival in patients with advanced heart failure. Whether the adverse impact on survival reflects an increased risk of pump failure or arrhythmic sudden death remains uncertain. If the ACE D genotype increases the risk of sudden death, implantable cardioverter defibrillator (ICD) therapy should diminish its negative impact. We sought to evaluate the effect of ICD therapy on ACE D genetic risk. Methods and Results: The Genetic Risk Assessment of Cardiac Events (GRACE) study enrolled 479 patients at the University of Pittsburgh between 1996 and 2001. Blood was genotyped for the ACE D/I (deletion/insertion) polymorphism. Of the 479 patients, 82 (77% male, 84% Caucasian, age 56 ± 11 years, 60% ischemic, left ventricular ejection fraction 0.23 ± 0.08) received an ICD and were selected for outcomes analysis (mean follow-up 871 ± 538 days). Transplant-free survival and survival alone were compared in ACE DD patients (n = 24, 29%) versus ACE DI/II patients (n = 58, 71%). Survival was significantly improved in ACE DI/II patients compared to those without an ICD (1 year: 93% vs 87%; 2 year: 89% vs 77%; P = 0.02) but not in ACE DD patients. Transplant-free survival among patients with an ICD was significantly worse in ACE DD versus ACE DI/II (1 year: 67% vs 88%, 2 year: 55% vs 80%, P = 0.03). Analysis of survival as a single endpoint revealed a similar result (1 year = 78% vs 94%; 2 year: 72% vs 88%; P = 0.05). ICD telemetry data showed a nonsignificant trend toward fewer individuals with arrhythmias in the ACE-DD group (46% vs 65%, P = 0.22) Conclusion: ICDs do not diminish the adverse influence of the ACE DD genotype on survival. This finding suggests that mortality in this high-risk genetic subset of patients is due to progression of heart failure rather than arrhythmic sudden death. [source] Sites of recurrence in oral and oropharyngeal cancers according to the treatment approachORAL DISEASES, Issue 3 2003AL Carvalho OBJECTIVE: The purpose of this study is to evaluate the rates and the sites of tumour recurrence in patients with oral and oropharyngeal carcinomas. DESIGN: This is a retrospective study of a series of cases treated in a single institution. PATIENTS AND METHODS: A series of 2067 patients with oral and oropharyngeal squamous carcinoma, treated from 1954 to 1998 were analysed. The treatment approach was: surgery, 624 cases (30.2%); radiotherapy alone, 729 cases (35.3%); radiotherapy and surgery, 552 cases (26.7%) and radiotherapy and chemotherapy, 162 cases (7.8%). MAIN OUTCOME MEASURES: Tumour recurrence was observed in 1079 patients (52.2%): 561 cases of local recurrences (27.1%); 168 neck recurrences (8.1%); 252 locoregional recurrences (12.2%); 59, distant metastasis (2.9%) and 39 (1.9%), combination of distant metastasis with local, neck or locoregional recurrence. RESULTS: The rates of recurrence varied significantly according to the treatment performed. Oral cavity cancer patients undergoing radiotherapy alone or in combination with chemotherapy presented the highest rates of neck recurrences (22.5 and 40.0%, respectively) for clinical stage (CS) I/II and of local (41.2 and 30.1%) and locoregional (21.7 and 31.1%) recurrences for CS III/IV; yet, for CS III/IV, surgery without neck dissection was associated with the highest rates of neck recurrences (20.7%), but no differences were observed in the rates of local or locoregional recurrences for CS I/II patients. For oropharynx cancer patients with CS I/II there was no difference in the rate of locoregional failures according to the treatment. However, patients with CS III/IV undergoing radiotherapy present a highest rate of local (42.3%) and locoregional (28.8%) failures. CONCLUSION: The results suggest that surgery should be the first option for initial clinical stage oral and oropharyngeal cancers. For advanced cases independently of the site of the tumour, surgery and postoperative radiotherapy should be the standard of care because it is associated with the lowest rates of locoregional recurrence. [source] Obesity As a Risk Factor for Sustained Ventricular Tachyarrhythmias in MADIT II PatientsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007GRZEGORZ PIETRASIK M.D. Background: Obesity, as defined by body mass index ,30 kg/m2, has been shown to be a risk factor for cardiovascular disease. However, data on the relationship between body mass index (BMI) and the risk of ventricular arrhythmias and sudden cardiac death are limited. The aim of this study was to evaluate the risk of ventricular tachyarrhythmias and sudden death by BMI in patients after myocardial infarction with severe left ventricular dysfunction. Methods: The risk of appropriate defibrillator therapy for ventricular tachycardia or ventricular fibrillation (VT/VF) by BMI status was analyzed in 476 nondiabetic patients with left ventricular dysfunction who received an implantable cardioverter defibrillator (ICD) in the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT II). Results: Mean BMI was 27 ± 5 kg/m2. Obese patients comprised 25% of the study population. After 2 years of follow-up, the cumulative rates of appropriate ICD therapy for VT/VF were 39% in obese and 24% in nonobese patients, respectively (P = 0.014). In multivariate analysis, there was a significant 64% increase in the risk for appropriate ICD therapy among obese patients as compared with nonobese patients, which was attributed mainly to an 86% increase in the risk of appropriate ICD shocks (P = 0.006). Consistent with these results, the risk of the combined endpoint of appropriate VT/VF therapy or sudden cardiac death (SCD) was also significantly increased among obese patients (Hazard Ratio 1.59; P = 0.01). Conclusions: Our findings suggest that in nondiabetic patients with ischemic left ventricular dysfunction, a BMI ,30 kg/m2 is an independent risk factor for ventricular tachyarrhythmias. [source] Mechanisms of Ventricular Fibrillation Initiation in MADIT II Patients with Implantable Cardioverter DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2008RYAN ANTHONY M.D. Background:The availability of stored intracardiac electrograms from implantable defibrillators (ICDs) has facilitated the study of the mechanisms of ventricular tachyarrhythmia onset. This study aimed to determine the patterns of initiation of ventricular fibrillation (VF) in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients along with associated electrocardiogram (ECG) parameters and clinical characteristics. Methods:Examination of stored electrograms enabled us to evaluate the rhythm preceding each episode of VF and to calculate (intracardiac) ECG parameters including QT, QT peak (QTp), coupling interval, and prematurity index. Results:Sixty episodes of VF among 29 patients (mean age 64.4 ± 2.5 years) were identified. A single ventricular premature complex (VPC) initiated 46 (77%) episodes whereas a short-long-short (SLS) sequence accounted for 14 (23%) episodes. Of the 29 patients studied, 23 patients had VF episodes preceded by a VPC only, two patients with SLS only, and four patients with both VPC and SLS-initiated episodes. There were no significant differences between initiation patterns in regards to the measured ECG parameters; a faster heart rate with SLS initiation (mean RR prior to VF of 655 ± 104 ms for SLS and 744 ± 222 ms for VPC) approached significance (P = 0.06). The two patients with SLS only were not on ,-blockers compared to 83% of the VPC patients. Conclusion:Ventricular fibrillation is more commonly initiated by a VPC than by a SLS sequence among the MADIT II population. Current pacing modes designed to prevent bradycardia and pause-dependent arrhythmias are unlikely to decrease the incidence of VPC-initiated episodes of VF. [source] Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II PatientsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Fredrik Holmqvist M.D., Ph.D. Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. Results: P-wave duration was 139 ± 23 ms and the RMS20 was 1.9 ± 1.1 ,V. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41,5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10,2.79, P = 0.019). Conclusion: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63,72 [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] Preliminary results of a fine-grain analysis of mood swings and treatment modalities of bipolar I and II patients using the daily prospective life-chart-methodologyACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009C. Born Objective:, The study aimed to increase the knowledge about the detailed course differences between different forms of bipolar disorder. Method:, Using the prospective life-chart-clinician version, we compared the fine-grain analysis of mood swings and treatment modalities of 18 bipolar II with 31 bipolar I patients. Results:, During an observational period of a mean of 26 months we observed an increase of euthymic days, and a decrease of (sub)depressive and (hypo)manic days. Days in a (sub)depressed state were more frequent than days of (hypo)mania as well as days of subdepression or hypomania in comparison to days of full-blown depression or mania. Bipolar II patients showed an increase in hypomanic days receiving more frequently antidepressants. Bipolar I patients, with a decrease of manic days, were significantly taking more often mood stabilizers. Conclusion:, Treatment in a specialized bipolar clinic improves the overall outcome, but bipolar II disorder seems to be still treated sub-optimally with a possible iatrogenic increase of hypomanic days. [source] Sphincter of Oddi dysfunction: role of sphincterotomyDIGESTIVE ENDOSCOPY, Issue 4 2001Choichi Sugawa Sphincter of Oddi dysfunction (SOD) is one of the causes of post-cholecystectomy syndrome and biliary pain and is a challenge from both the diagnostic and therapeutic points of view. Sphincter of Oddi dysfunction is typically diagnosed months to years after cholecystectomy. Continued biliary type pain after cholecystectomy may occur in as many as 10,20% of patients. Ten percent or more of these patients may eventually be shown to have SOD. The syndrome is often associated with a variety of other gastrointestinal disorders thought to be caused by dysmotility. According to the Milwaukee classification, patients with biliary pain can be divided into three types. Type I patients show all the objective signs suggestive of a disturbed bile outflow (i.e. elevated liver function tests, dilated common bile duct and delayed contrast drainage during endoscopic retrograde cholangiopancreatography). Type II patients have biliary type pain along with one or two of the criteria from type I. Type III patients have biliary pain only, with no other abnormalities. The present paper will focus primarily on SOD syn-drome, papillary stenosis and the diagnostic and therapeutic approaches, in particular endoscopic sphincterotomy. [source] Cytotoxic factor-autoantibodies: possible role in the pathogenesis of dengue haemorrhagic feverFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2001U.C. Chaturvedi Abstract During dengue virus infection a unique cytokine, cytotoxic factor (hCF), is produced that is pathogenesis-related and plays a key role in the development of dengue haemorrhagic fever (DHF). However, what regulates the adverse effects of hCF is not known. We have previously shown that anti-hCF antibodies raised in mice, neutralise the pathogenic effects of hCF. In this study we have investigated the presence and levels of hCF-autoantibodies in sera of patients with various severity of dengue illness (n=136) and normal healthy controls (n=50). The highest levels of hCF-autoantibodies (mean±S.D.=36±20 U ml,1) were seen in patients with mild illness, the dengue fever (DF), and 48 out of 50 (96%) of the sera were positive. On the other hand the hCF-autoantibody levels declined sharply with the development of DHF and the levels were lowest in patients with DHF grade IV (mean±S.D.=5±2 U ml,1; P=<0.001 as compared to DF). Only one of the 13 DHF grade IV patients had an antibody level above the ,cut-off' value (mean plus 3 S.D. of the control sera). The analysis of data with respect to different days of illness further showed that the highest levels of hCF-autoantibodies were present in DF patients at >9 days of illness. Moreover, the DF patients at all time points, i.e. 1,4, 5,8 and >9 days of illness had significantly higher levels of hCF-autoantibodies (P<0.001) than patients with DHF grade I, II, III and IV. In addition DHF grade I and grade II patients had significantly more positive specimens than DHF grade III and grade IV patients at all time points. These results suggest that elevated levels of hCF-autoantibodies protect the patients against the development of severe forms of DHF and, therefore, it may be useful as a prognostic indicator. [source] Promising data for Crataegus berries in NYHA II patientsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2003Article first published online: 14 JUN 2010 [source] Low dose radiotherapy in indolent lymphomas, enough is enough,HEMATOLOGICAL ONCOLOGY, Issue 2 2009R. L. M. Haas MD. Abstract Follicular lymphomas, as a prototype of all indolent lymphomas, are exquisitely radiation sensitive. This review paper highlights the clinical presentation of this lymphoma entity. Literature data are presented on first line curative irradiation in stage I and II patients, low-dose total body irradiation (TBI) in stage III and IV patients in first line and low-dose IF-RT (involved field radiotherapy) in patients with relapse. The clinical aspects of 2,×,2,Gy IF-RT in follicular lymphoma (FL) are presented as well as the in vivo imaging of the apoptotic cell death underlying the clinical response. Finally, by gene expression profiling, possible molecular-biological pathways are described involved in the low dose irradiation of FL. Copyright © 2009 John Wiley & Sons, Ltd. [source] Larger tidal volume increases sevoflurane uptake in blood: a randomized clinical studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010B. ENEKVIST Background: The rate of uptake of volatile anesthetics is dependent on alveolar concentration and ventilation, blood solubility and cardiac output. We wanted to determine whether increased tidal volume (VT), with unchanged end-tidal carbon dioxide partial pressure (PETCO2), could affect the arterial concentration of sevoflurane. Methods: Prospective, randomized, clinical study. ASA physical status 2 and II patients scheduled for elective surgery of the lower abdomen were randomly assigned to one of the two groups with 10 patients in each: one group with normal VT (NVT) and one group with increased VT (IVT) achieved by increasing the inspired plateau pressure 0.04 cmH2O/kg above the initial plateau pressure. A corrugated tube added extra apparatus dead space to maintain PETCO2 at 4.5 kPa. The respiratory rate was set at 15 min,1, and sevoflurane was delivered to the fresh gas by a vaporizer set at 3%. Arterial sevoflurane tensions (Pasevo), Fisevo, PETsevo, PETCO2, PaCO2, VT and airway pressure were measured. Results: The two groups of patients were similar with regard to gender, age, weight, height and body mass index. The mean PETsevo did not differ between the groups. Throughout the observation time, arterial sevoflurane tension (mean±SE) was significantly higher in the IVT group compared with the NVT group, e.g. 1.9±0.23 vs. 1.6±0.25 kPa after 60 min of anesthesia (P<0.05). Conclusion: Ventilation with larger tidal volumes with isocapnia maintained with added dead-space volume increases the tension of sevoflurane in arterial blood. [source] Detailed examination of lymph nodes improves prognostication in colorectal cancerINTERNATIONAL JOURNAL OF CANCER, Issue 11 2010Fania S. Doekhie Abstract Up to 30% of stage II patients with curatively resected colorectal cancer (CRC) will develop disease recurrence. We evaluated whether examination of lymph nodes by multilevel sectioning and immunohistochemical staining can improve prognostication. Lymph nodes (n = 780) from 36 CRC patients who had developed disease recurrence (cases) and 72 patients who showed no recurrence of disease for at least 5 years (controls) were analyzed. Sections of 4 levels at 200-,m interval were immunohistochemically stained for cytokeratin expression. The first level was analyzed by conventional and automated microscopy, and the 3 following levels were analyzed by automated microscopy for the presence of tumor cells. Overall, cases showed more micrometastases (3 patients) than controls (1 patient). Analysis of a second level led to the additional detection of 1 patient with micrometastases (case) and 1 patient with macrometastasis (case). Examining more levels only led to additional isolated tumor cells, which were equally divided between cases and controls. Likewise, automated microscopy resulted only in detection of additional isolated tumor cells when compared with conventional microscopy. In multivariate analysis, micrometastases [odds ratio (OR) 26.3, 95% confidence interval (CI) 1.9,364.8, p = 0.015], T4 stage (OR 4.8, 95% CI 1.4,16.7, p = 0.013) and number of lymph nodes (OR 0.9, 95% CI 0.8,1.0, p = 0.028) were independent predictors for disease recurrence. Lymph node analysis of 2 levels and immunohistochemical staining add to the detection of macrometastases and micrometastases in CRC. Micrometastases were found to be an independent predictor of disease recurrence. Isolated tumor cells were of no prognostic significance. [source] Beating Heart Ischemic Mitral Valve Repair and Coronary Revascularization in Patients with Impaired Left Ventricular FunctionJOURNAL OF CARDIAC SURGERY, Issue 5 2003Edvin Prifti M.D., Ph.D. Materials and Methods: Between January 1993 and February 2001, 91 patients with LVEF between 17% and 35% and chronic ischemic MVR (grade III,IV), underwent MV repair in concomitance with coronary artery bypass grafting (CABG) Sixty-one patients (Group I) underwent cardiac surgery with cardioplegic arrest, and 30 patients (Group II) underwent beating heart combined surgery. Aortic valve insufficiency was considered a contraindication for the on-pump/beating heart procedure. Mean age in Group I was 64.4 ± 7 years and in Group II, 65 ± 6 years (p = 0.69). Results: The in-hospital mortality in Group I was 8 (13%) patients versus 2 (7%) patients in Group II (p > 0.1). The cardiopulmonary bypass (CPB) time was significantly higher in Group I (p < 0.001). In Groups I and II, respectively (p > 0.1), 2.5 ± 1 and 2.7 ± 0.8 grafts per patient were employed. Perioperative complications were identified in 37 (60.7%) patients in Group I versus 10 (33%) patients in Group II (p = 0.025). Prolonged inotropic support of greater than 24 hours was needed in 48 (78.7%) patients (Group I) versus 15 (50%) patients (Group II) (p = 0.008). Postoperative IABP and low cardiac output incidence were significantly higher in Group I, p = 0.03 and p = 0.027, respectively. Postoperative bleeding greater than 1000 mL was identified in 24 patients (39.4%) in Group I versus 5 (16.7%) in Group II (p = 0.033). Renal dysfunction incidence was 65.6% (40 patients) in Group I versus 36.7% (11 patients) in Group II (p = 0.013). The echocardiographic examination within six postoperative months revealed a significant improvement of MV regurgitation fraction, LV function, and reduced dimensions in both groups. The postoperative RF was significantly lower in Group II patients 12 ± 6 (%) versus 16 ± 5.6 (%) in Group I (p = 0.001). The 1, 2, and 3 years actuarial survival including all deaths was 91.3%, 84.2%, and 70% in Group I and 93.3%, 87.1%, and 75% in Group II (p = ns). NYHA FC improved significantly in all patients from both groups. Conclusion. We conclude that patients with impaired LV function and ischemic MVR may undergo combined surgery with acceptable mortality and morbidity. The on/pump beating heart MV repair simultaneous to CABG offers an acceptable postoperative outcome in selected patients. [source] The Clinical Implications of Cumulative Right Ventricular Pacing in the Multicenter Automatic Defibrillator Trial IIJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2005JONATHAN S. STEINBERG M.D. Introduction: This study was designed to assess whether right ventricular pacing in the implantable cardioverter defibrillator (ICD) arm of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II was associated with an unfavorable outcome. Methods and Results: Data on the number of ventricular paced beats were available in 567 (76%) of 742 MADIT II patients with ICDs. The number of ventricular paced beats over the total number of beats showed a bimodal distribution with patients being predominantly paced or nonpaced. Therefore, patients were dichotomized at 0,50% and 51,100% of cumulative pacing with median pacing rate 0.2% and 95.6%, respectively. Endpoints included new or worsening heart failure, appropriate ICD therapy for VT/VF, and the combined endpoint of heart failure or death. Clinical features associated with frequent ventricular pacing included age ,65 years, advanced NYHA heart failure class, LVEF < 0.25, first degree AV and bundle branch block, and amiodarone use. During follow-up, 119 patients (21%) had new or worsened heart failure, 130 (23%) had new or worsened heart failure or death, and 142 (25%) had appropriate therapy for VT/VF. In comparison to patients with infrequent pacing, those with frequent pacing had significantly higher risk of new or worsened heart failure (hazard ratio = 1.93; P = 0.002) and VT/VF requiring ICD therapy (HR = 1.50; P = 0.02). Conclusions: Patients in MADIT II who were predominantly paced had a higher rate of new or worsened heart failure and were more likely to receive therapy for VT/VF. These results suggest the deleterious consequences of RV pacing, particularly in the setting of severe LV dysfunction. [source] Chromogenic in situ hybridization analysis of melastatin mRNA expression in melanomas from American Joint Committee on Cancer stage I and II patients with recurrent melanomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 9 2006L. Hammock Objective:, To determine whether loss of melastatin (MLSN) is a universal phenomenon in American Joint Committee on Cancer (AJCC) stage I and II melanoma patients who experienced recurrence. Material and methods:, Paraffin blocks of primary melanomas (PMs) were retrieved from 30 patients who had a negative sentinel lymph node biopsy and developed recurrent melanoma (AJCC stage I and II). Chromogenic in situ hybridization (CISH) methods were utilized to evaluate the expression of MLSN mRNA. These results were correlated with clinicopathologic data. Results:, Variable, heterogeneous expression of MLSN mRNA was identified in normal, in situ and invasive melanocytes within and between cases. For the invasive PM component, 24 (80%) had focal, regional or complete loss of MLSN mRNA. The remaining 20% had either regional or total partial downregulation of MLSN mRNA. Intact MLSN mRNA expression was present regionally in 14/30 (47%), with mean relative tumor area of 38%, range 5,85%. Increasing loss of MLSN mRNA significantly correlated with increasing tumor depth and microsatellites (r = 0.1/0.4, p = 0.04). However, thin, AJCC T stage 1a PM had higher relative mean loss than intermediate AJCC T stage 2a/2b/3a thickness PM (65% vs. 34%/48%/25%). Increasing loss of MLSN mRNA significantly impacted on disease free survival (DFS) by multivariate analysis (58 vs. 0% 2 years DFS, , 75 vs. >75% mRNA loss, p = 0.02). Decreased overall survival significantly correlated with increasing age and vascular invasion on multivariate analysis. Conclusion:, Extensive loss of MLSN in PM correlated with aggressive metastatic melanoma. Ancillary testing for MLSN mRNA expression by CISH could offer a means to more accurately identify AJCC stage I and II patients at risk for metastatic disease, who could benefit from adjuvant therapy. [source] Comparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009J. AGARWAL Background: In recent years, electroencephalographic indices of anaesthetic depth have facilitated automated anaesthesia delivery systems. Such closed-loop control of anaesthesia has been described in various surgical settings in ASA I,II patients (1,4), but not in open heart surgery characterized by haemodynamic instability and higher risk of intra-operative awareness. Therefore, a newly developed closed-loop anaesthesia delivery system (CLADS) to regulate propofol infusion by the Bispectral index (BIS) was compared with manual control during open heart surgery. Methods: Forty-four adult ASA II,III patients undergoing elective cardiac surgery under cardiopulmonary bypass were enrolled. The study participants were randomized to two groups: the CLADS group received propofol delivered by the CLADS, while in the manual group, propofol delivery was adjusted manually. The depth of anaesthesia was titrated to a target BIS of 50 in both the groups. Results: During induction, the CLADS group required lower doses of propofol (P<0.001), resulting in lesser overshoots of BIS (P<0.001) and mean arterial blood pressure (P=0.004). Subsequently, BIS was maintained within ± 10 of the target for a significantly longer time in the CLADS group (P=0.01). The parameters of performance assessment, median absolute performance error (P=0.01), wobble (P=0.04) and divergence (P<0.001), were all significantly better in the CLADS group. Haemodynamic stability was better in the CLADS group and the requirement of phenylephrine in the pre-cardiopulmonary bypass period as well as the cumulative dose of phenylephrine used were significantly higher in the manual group. Conclusion: The automated delivery of propofol using CLADS was safe, efficient and performed better than manual administration in open heart surgery. [source] HHV8 a subtype is associated with rapidly evolving classic Kaposi's sarcomaJOURNAL OF MEDICAL VIROLOGY, Issue 12 2008Roberta Mancuso Abstract The link between human herpesvirus 8 (KSHV) and Kaposi's sarcoma (KS) has been proven, but many important aspects including risk factors, genetic predisposition to tumor development, transmission of KSHV, and the pathogenic potential of different genotypes remain to be elucidated. Possible associations between clinical parameters and antibody levels, viral load fluctuations, and viral genotype were analyzed by quantitative real-time PCR, an in-house developed IFA assay, and sequence analysis of ORF K1-VR1 in blood, serum and saliva of 38 subjects with classic KS (cKS). KSHV lytic antibodies were significantly increased in stage IV compared to stage I and II patients (p,=,0.006 and p,=,0.041, respectively). KSHV blood, serum, and saliva viral load was comparable in all stages. The highest viral loads were detected in saliva, and they decreased in stages III,IV compared to stages I,II patients. Higher concentrations of lytic antibodies and higher viral loads were observed in fast progressing cKS patients, in whom KSHV detection from blood was also more frequent. Type A KSHV strain was almost exclusively present in rapid progressors (12/17 cases), while C type was mainly present in slow progressing patients (6/7 cases). Finally, detection of type A KSHV strain associated with higher blood viral loads. KSHV lytic antibody levels and viral load can be used to monitor clinical evolution of cKS. Infection supported by KSHV A subtype is associated with more rapid progressive disease. Careful monitoring and aggressive therapeutic protocols should be considered in patients with KSHV A-supported infection. J. Med. Virol. 80:2153,2160, 2008. © 2008 Wiley-Liss, Inc. [source] Analysis of risk factors for recurrence and effective adjuvant therapy in patients with endometrial cancerJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2002Tomoko Goto Objective: The aim of this study was to explore risk factors for recurrence and effective adjuvant therapy in endometrial cancer. Methods: Between 1985 and 1999, 170 patients with uterine endometrial cancer received initial therapy at the National Defense Medical College Hospital. We retrospectively analyzed risk factors including; histopathological features, operative procedures, adjuvant therapies and surgical staging. Results: Although the prognosis in stage I and II patients was fairly good, recurrences were observed in patients with stage Ib or worse. Vagina walls were the frequent site of recurrence. About a half of relapses which occurred within seven months after surgery were observed during adjuvant chemotherapy. Multivariate analysis revealed that myometrial invasion (P = 0.0231) was the only risk factor for recurrence. Although the prognosis in stage III and IV patients was generally poor, serosal invasion in stage III disease seemed to be an im-portant risk factor. With regard to adjuvant therapy in stage I,III patients who could receive optimal cytoreductive surgery; the risk of recurrence was significantly (P = 0.0127) lower in patients receiving radiation therapy than in those receiving chemotherapy including platinum agents. Conclusion: The data suggested that in stage I,III patients with optimal cytoreductive surgery, myometrial invasion is an independent risk factor for recurrence and radiation therapy is more effective than chemotherapy as adjuvant therapy. [source] A Novel Single Nucleotide Polymorphism of the Neuropeptide Y (NPY) Gene Associated With Alcohol DependenceALCOHOLISM, Issue 5 2005Salim Mottagui-Tabar Background: Neuropeptide Y (NPY) is a major endogenous regulator of anxiety-related behaviors and emotionality. Transgenic work with NPY and null-mutant mice have implicated NPY in the control of alcohol consumption, suggesting that genetic variation of the prepro-NPY gene may also contribute to the heritability of alcoholism. The aim of this study was to examine whether polymorphic variants of the NPY gene are associated with the diagnosis of alcohol dependence. Methods: We compared allele frequencies of 5 NPY polymorphisms (,883-ins/del, ,602, ,399, ,84, and +1128) in a Nordic population of alcohol-dependent individuals (n= 428 males; n= 149 females) and ethnically matched controls (n= 84 males; n= 93 females) for whom alcohol dependence or any diagnosis of substance disorder was excluded. Patients were further subtyped into type I (late-onset) and type II (early-onset) alcoholics. Results: The ,602 marker showed a significant association with alcohol dependence (p= 0.0035; OR, 2.3; 95% CI, 1.3-4.0); a trend level association was further observed for the ,399 marker (p= 0.058; OR, 1.3; 95% CI, 0.99-1.7) and the +1128 marker (p= 0.053; OR, 1.8; 95% CI, 0.99-3.1). The association for the ,602 marker remained and was strengthened when analyzed in type I subjects only, although this association was not seen in type II patients, and there also was a significant association in the female subjects but not in males. The ,602 single nucleotide polymorphism was in strong linkage dysequilibrium (r2= 0.7; p < 0.0001) with the +1128 single nucleotide polymorphism, which has previously been reported to be associated with a diagnosis of alcoholism. Haplotype-based association confirmed these results. Conclusions: We report a novel polymorphism at position ,602 in the 5, region of the NPY gene that is significantly associated with alcohol dependence. We also describe the haplotype frequencies and linkage dysequilibrium pattern of four variations in that region. [source] Electrophysiological findings of peripheral neuropathy in newly diagnosed type II diabetes mellitusJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 4 2005Eugenia Rota Abstract This study was aimed at assessing the electrophysiological signs of peripheral neuropathy in diabetes mellitus (DM) type II patients at diagnosis. Nerve conduction studies (NCS) of median, ulnar, peroneal, tibial and sural nerves were performed in 39 newly diagnosed DM subjects and compared to those of 40 healthy controls. Metabolic indices were also investigated. Electrophysiological alterations were found in 32 (82%) of the DM patients, and more than half of them (62.2%) showed multiple (two to five) abnormal parameters. Because most of the subjects (84.4%) had from two to five nerves involved, these alterations were widespread in the seven nerves evaluated. Forty-two percent of the patients had NCS alterations suggestive of distal median mononeuropathy, implying that metabolic factors in DM make the median nerve more susceptible to focal entrapment. A reduced sensory nerve action potential (SNAP) amplitude was observed in the median nerve in 70% of the patients, in the ulnar in 69% and in the sural nerve only in 22%. In the presence of a decrease in the SNAP amplitude of the ulnar or median nerve, the SNAP amplitude of the sural nerve was normal in 82 or 80% of the subjects, respectively. This finding may be in keeping with a distal involvement of the sensory fibres, as explored by routine median or ulnar NCS. No correlation was found between metabolic indices and NCS parameters. In conclusion, a high percentage of newly diagnosed DM patients show signs of neuropathy, and upper limb nerve sensory NCS seem to be more sensitive in detecting it than lower limb NCS. [source] Liver transplantation for non,hepatocellular carcinoma malignancy: Indications, limitations, and analysis of the current literatureLIVER TRANSPLANTATION, Issue 8 2010Eric J. Grossman Orthotopic liver transplantation (OLT) is currently incorporated into the treatment regimens for specific nonhepatocellular malignancies. For patients suffering from early-stage, unresectable hilar cholangiocarcinoma (CCA), OLT preceded by neoadjuvant radiotherapy has the potential to readily achieve a tumor-free margin, accomplish a radical resection, and treat underlying primary sclerosing cholangitis when present. In highly selected stage I and II patients with CCA, the 5-year survival rate is 80%. As additional data are accrued, OLT with neoadjuvant chemoradiation may become a viable alternative to resection for patients with localized, node-negative hilar CCA. Hepatic involvement from neuroendocrine tumors can be treated with OLT when metastases are unresectable or for palliation of medically uncontrollable symptoms. Five-year survival rates as high as 90% have been reported, and the Ki67 labeling index can be used to predict outcomes after OLT. Hepatic epithelioid hemangioendothelioma is a rare tumor of vascular origin. The data from single-institution series are limited, but compiled reviews have reported 1- and 10-year survival rates of 96% and 72%, respectively. Hepatoblastoma is the most common primary hepatic malignancy in children. There exist subtle differences in the timing of chemotherapy between US and European centers; however, the long-term survival rate after transplantation ranges from 66% to 77%. Fibrolamellar hepatocellular carcinoma is a distinct liver malignancy best treated by surgical resection. However, there is an increasing amount of data supporting OLT when resection is contraindicated. In the treatment of either primary or metastatic hepatic sarcomas, unacceptable survival and recurrence rates currently prohibit the use of OLT. Liver Transpl 16:930-942, 2010. © 2010 AASLD. [source] Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ,Botox vs.ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2004Dysport' controlled trial Summary Background :,Botulinum neurotoxin induces healing in patients with idiopathic fissure. The optimal dosage is not well established. Aim :,To compare the efficacy and tolerability of two different formulations of type A botulinum neurotoxin, and to provide more evidence with regard to the choice of dosage regimens. Methods :,Symptomatic adults with chronic anal fissure were enrolled in a randomized study. The outcome of each group was evaluated clinically, and by comparing the pressure of the anal sphincters before and after treatment. Results :,Fifty patients received injections of 50 units of Botox formulation (group I), and 50 patients received injections of 150 units of Dysport toxin (group II). One month after injection, 11 patients in group I and eight in group II had mild incontinence of flatus. At the 2-month evaluation point, 46 patients in group I and 47 patients in group II had a healing scar. In group I patients, the mean resting anal pressure was 41.8% lower, and the maximum voluntary squeeze pressure was 20.2% lower, than the baseline value. In group II patients, the resting anal pressure and maximum voluntary squeeze pressure were 60.0 ± 12.0 mmHg and 71.0 ± 30.0 mmHg, respectively. There were no relapses during an average of about 21 months of follow-up. Conclusions :,Botulinum neurotoxin may be considered an effective treatment in patients with chronic anal fissure. The efficacy and tolerability of the two different formulations of botulinum neurotoxin were indistinguishable. [source] Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2005G. M. Koksal Background:, This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response. Methods:, Sixty ASA I,II patients, scheduled for tympanoplasty, were randomly allocated to be anaesthetized with either sevoflurane or desflurane at maintenance inspiratory concentrations of 1,1.5 MAC of either agent. Blood samples were taken for plasma tumour necrosis factor , (TNF,), interleukin 1, and interleukin-6 assay before induction of anaesthesia, before surgery, and at the end of surgery. Alveolar cells were obtained after induction of anaesthesia and at the end of surgery. Results:, Plasma TNF, was greater with desflurane than sevoflurane both before surgery (45.1 ± 3.5 pg ml,1 for desflurane vs. 23.2 ± 2.5 pg ml,1 for sevoflurane, P < 0.01) and (62.0 ± 5.3 pg ml,1 vs. 35.5 ± 4.6 pg ml,1, P < 0.001). Interleukin 1, was similarly greater with desflurane than sevoflurane before (39.3 ± 4.0 pg ml,1 vs. 17.4 ± 3.0 pg ml,1; P < 0.01) and after surgery (46.0 ± 3.4 pg ml,1 vs. 23.3 ± 3.2 pg ml,1, P < 0.001). There were similar results for interleukin 6 before (42.3 ± 3.5 pg mls,1. 29.0 ± 2.6 pg ml,1, P < 0.001) and after surgery (86.0 ± 4.5 pg ml,1 vs. 45.9 ± 6.3 pg ml,1, P < 0.001). Alveolar cell TNF, concentrations after surgery were also greater with desflurane than sevoflurane (96.3 ± 12.4 pg ml,1 vs. 64.8 ± 10.1 pg ml,1, P < 0.001), as were interleukin 1, (75.4 ± 6.2 pg ml,1 vs. 32.0 ± 8.3 pg ml,1, P < 0.001) and interleukin 6 concentrations (540.1 ± 65.3 pg ml,1 vs. 363.6 ± 29.2 pg ml,1, P < 0.001). Conclusion:, Desflurane appears to cause a greater systemic and intrapulmonary pro-inflammatory response than sevoflurane during anaesthesia for ear surgery. [source] Comparison of recovery properties of desflurane and sevoflurane according to gender differencesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2005E. Tercan Background:, The aim of this study was to investigate the recovery properties of desflurane and sevoflurane in patients undergoing elective surgery, according to the gender differences. Methods:, In the study, 160 ASA class I,II patients aged between 20 and 60 years were included. The patients were assigned into two groups according to their gender, and these groups were randomly divided into two groups according to a selected volatile anaesthetic agent. Intraoperative bispectral index, time of postoperative achievement for end-tidal concentrations of volatile agents to decline 50% (ET-AA%50), time for extubation, time for eye opening and orientation, and time for bispectral index values to reach control values were recorded. Aldrete scores and error points of a delayed memory recall test were determined. Results:, Desflurane groups had a shorter ET-AA%50 time, extubation and eye-opening time in male and female patients compared to the sevoflurane groups, and these results were statistically significant (P < 0.05). In both the desflurane and sevoflurane groups, ET-AA%50 time, extubation and eye-opening time were shorter in male patients than in female patients, and these results were also statistically significant (P < 0.05). There were no significant differences among the groups in terms of Aldrete scores and error points of delayed memory recall test (P > 0.05). Conclusion:, In conclusion, early recovery time was shorter in male patients compared to female patients in both the desflurane and sevoflurane groups. Additionally, in the desflurane groups it was shorter in the sevoflurane groups for both genders. [source] Analgesic effects of preincisional administration of dextromethorphan and tenoxicam following laparoscopic cholecystectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2004C-C. Yeh Background:, Pre-incisional treatment with either N -methyl-D-aspartate (NMDA) receptor antagonists or non-steroidal anti-inflammatory drugs (NSAIDs) improves postoperative pain relief. This study examines the effect on postlaparoscopic cholecystectomy (LC) pain of a combination of dextromethorphan (DM), a NMDA-receptor antagonist, and tenoxicam, a NSAID, given preoperatively. Methods:, Eighty-eight ASA I or II patients scheduled for LC were entered into a randomized, double-blind study and randomly allocated to one of four groups. Controls received 20 mg (4 ml) of chlorpheniramine maleate (CPM) IM and 4 ml of normal saline (N/S) IV. Group DM received 40 mg of DM (containing 20 mg of CPM) IM and 4 ml of N/S IV. Group T were given CPM 20 mg IM, and tenoxicam 40 mg (4 ml) IV. Group DM + T were given DM 40 mg (containing 20 mg of CPM) IM, and tenoxicam 40 mg IV. All treatments were given 30 min before skin incision. Analgesic effects were evaluated by Visual Analog Scale (VAS) pain scores at rest and during coughing, at 1, 2, 4, 12, 24 and 48 h after surgery. The time to the first request for meperidine for pain relief, and total meperidine consumption, were recorded for 48 h after surgery. Results:, Compared to controls, patients given DM and DM + T first requested meperidine significantly later, had lower meperidine consumption, made fewer requests for meperidine, and had lower pain scores. There were significant differences between the DM + T and T groups at 2 and 4 h in both resting and incident VAS pain scores, the incidence of meperidine requests and the time to first meperidine injection. There were significant differences between groups DM and T at 1 h for resting pain and at 2 and 4 h for incident pain. Except for a significant difference in the incident pain score 1 h after surgery, there were no other differences in pain scores between the DM and DM + T groups. Neither synergistic nor antagonistic interaction was observed between DM and tenoxicam. Conclusions:, The results suggest that pretreatment with DM, but not tenoxicam, provides significant pre-emptive analgesia for postoperative pain management in patients after LC surgery. Combining DM and tenoxicam also gives good pain relief. [source] Relationship between urinary profile of the endogenous steroids and postmenopausal women with stress urinary incontinenceNEUROUROLOGY AND URODYNAMICS, Issue 3 2003S.W. Bai Abstract Aims The aims of this study were to investigate whether endogenous steroid hormones are (1) related to pathogenesis of stress urinary incontinence after menopause, (2) are related to severity of stress urinary incontinence, and (3) are related to prognostic parameters of stress urinary incontinence. Methods Twenty post-partum women with clinically diagnosed stress urinary incontinence and 20 age-matched postmenopausal women without stress urinary incontinence (control group) were evaluated. We compared urinary profile of the endogenous steroid hormones patients with stress urinary incontinence and controls, and between grade I and grade II of stress urinary incontinence. We also in vestigated the relationship between urinary profile of the endogenous steroid hormones and prognostic parameters of stress urinary incontinence (maximal urethral closure pressure, functional urethral length, Valsalva leak point pressure, cough leak point pressure, posterior urethrovesical angle, bladder neck descent, and stress urethral axis). The ages of the patients and those in the control group were 64.3,±,5.6 and 57.5,±,3.8 years old and the body mass indexes were 24.96,±,3.14 and 22.11,±, 2.73 kg/m2 in patients and in normal subjects, respectively. Nine patients were grade I and 11 were grade II. Estrone and 17,-estradiol only were detected in all subjects, regardless of control or patient group. It is noteworthy that there were no significant differ ences (P,>,0.05) in the levels of estrone and 17,-estradiol in the urine of postmenopausal normal subjects compared with in the urine of postmenopausal patients with urinary incontinence. E2/E1 ratio was not different between the two groups (P,>,0.05). Among the objective steroids, DHEA, ,4 -dione, ,5 -diol, Te, DHT, 16,-DHT, 11-keto An, THDOC, and THB were not detected either in the urine of normal subjects and nor in the urine of the patients. After comparing androgen levels between normal subjects and patients, no significant differences (P>0.05) were detected, except for 5,-THB and 5,-THF. Neither 5,-THB or 5,-THF were detected in the patients' urine. Et/An (11,-OH Et/11,-OH An) concentration ratios were not significantly different between the two groups, either (P,>,0.05). There were not significant differences of concentrations (,mol/g creatinine) of urinary steroids between grade I and grade II of stress urinary incontinence. Pregnanediol was significantly related to bladder neck descent in supine and sitting positions (R,=,0.79, P,=,0.01, and R,=,0.73, P,=,0.03, respectively), and pregnanetriol was significantly related to maximal urethral closure pressure and functional urethral length (R,=,0.68, P,=,0.04, and R,=,,0.79, P,=,0.01, respectively). Androsterone was significantly related to bladder neck descent in supine and sitting positions (R,=,0.68, P,=,0.04, and R,=,0.78, P,=,0.01, respectively). 5-AT was significantly related to bladder neck descent in sitting position and stress urethral axis (R,=,0.72, P,=,0.03, and R,=,,0.71, P,=,0.03). 11-Keto Et was significantly related to bladder neck descent in supine and sitting positions and related to stress ure thral axis (R,=,0.82, P,=,0.01, and R,=,0.81, P,=,0.01, R,=,,0.67, P,=,0.04, respectively). THS was signi ficantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R,=,0.76, P,=,0.02, and R,=,0.74, P,=,0.02, R,=,,0.68, P,=,0.04, respectively). THE was significantly related to bladder neck descent in sitting position (R,=,0.67, P,=,0.04).,-Tetrahydrocortisol/,-tetrahydrocortisol (,-THF/,-THF) and ,-cortol were significantly related to maximal urethral closure pressure and functional urethral length (R,=,0.74, P,=,0.02, and R,=,,0.92, P,=,0.01; R,=,0.71, P,=,0.36, and R,=,,0.87, P,=,0.000, respectively). 17,-Estradiol (E2) was significantly related to bladder neck descent in supine position (R,=,,0.62, P,=,0.04) and 17,-estradiol/estrone (E2/E1) was significantly related to cough leak point pressure (R,=,0.79, P,=,0.01). In conclusion, the urinary concentrations of endogenous steroid metabolites in postmenopausal patients with stress urinary incontinence were not significantly different from normal patients and were not significantly different between grade I and grade II patients with stress urinary incontinence. Some endogenous steroid metabolites were positively or negatively significantly related to prognostic parameters of stress urinary incontinence. Neurourol. Urodynam. 22:198,205, 2003. © 2003 Wiley-Liss, Inc. [source] Cephalometric evaluation of the effects of pendulum appliance on various vertical growth patterns and of the changes during short-term stabilizationORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 1 2001Ms Toro The aim of this study was to evaluate the effects of the pendulum appliance in dental Class II patients with varying vertical growth patterns and to evaluate the changes during the short-term stabilization period of 3 months. The sample (n=30) was divided into two groups based on their FMA°. The high-angle group consisted of 14 patients (10 girls and 4 boys) and had a mean age of 157.7±8.0 months. The low-angle group consisted of 16 patients (8 girls and 8 boys) and had a mean age of 155.5±18.6 months. Pretreatment, posttreatment and poststabilization cephalometric radiographs were obtained to measure the changes. Mann,Whitney U and Wilcoxon tests were used for statistical evaluation. The amount of upper molar distalization was 5.9 mm (p<0.001) in the high-angle group and 1 mm (p<0.001) in the low-angle group, showing no intergroup difference. The amount of anchorage loss at the second premolars was 4.8 mm (p<0.001) in the high-angle group and 6.6 mm (p<0.001) in the low-angle group. Upper incisors moved anteriorly for 2.1 mm (p<0.05) in the high-angle group and 4.1 mm (p<0.001) in the low-angle group. Intergroup difference was statistically significant (p<0.001). During the stabilization period, 1.5 mm of anchorage loss was measured at the upper molar region in the high-angle group and 1.7 mm of anchorage loss was measured at the upper molar region in the low-angle group. During the stabilization period, upper second premolars and incisors tended to move back to their original places. The results of this study showed that pendulum appliance could move the upper molars distally in a short period of time without depending on the patient compliance. Care should be taken to prevent anchorage loss and to stabilize the upper molars for, at least, 3 months. [source] A Prognostic Index Relating 24-Hour Ambulatory Blood Pressure to Cardiac Events in Ischemic Cardiomyopathy Following Defibrillator ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008LANFRANCO ANTONINI M.D. Background:We assessed the role of left ventricular ejection fraction and of ambulatory blood pressure monitoring (ABPM) to predict cardiac death and heart failure in patients with defibrillator fulfilling MADIT II criteria. ABPM variables assessed included: mean 24 hours diastolic and systolic blood pressure, mean 24 hours heart rate, and pulse pressure. Methods:We studied 105 consecutive patients (age 67 ± 11), all with a defibrillator and ejection fraction , 30%). Results:At 1-year follow-up, there were 29 events (25%), three cardiac deaths, and 26 hospitalizations for heart failure. Age, creatinine, mean 24 hours diastolic blood pressure, and mean 24 hours systolic blood pressure (but not ejection fraction) were associated with events. A prognostic index (PI) was built by age and ABPM variables, according to the formula (120 , age) + (mean 24 hours diastolic blood pressure + mean 24 hours systolic blood pressure). Receiver operating characteristic curves showed the best cutoff for PI = 220 (sensitivity 81%, specificity 71%, positive predictive value 56%, negative predictive value 88%). Cox regression analysis confirmed the significant association between lower PI (< 220) and clinical events (HR 4.8, 95% CI 1.8,12.3, P = 0.0001 for PI). Overall, 12% of patients with high PI values (, 220 n = 71) had clinical events at 12-month follow-up, compared with 61% of patients with low PI (< 220 n = 34) (P < 0.0001). Conclusion:The PI built by mean 24 hours diastolic and systolic blood pressure and age could be a simple method to stratify risk of cardiac death and acute heart failure in MADIT II patients, in whom ejection fraction, uniformly depressed, is not predictive. [source] Mechanisms of Ventricular Fibrillation Initiation in MADIT II Patients with Implantable Cardioverter DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2008RYAN ANTHONY M.D. Background:The availability of stored intracardiac electrograms from implantable defibrillators (ICDs) has facilitated the study of the mechanisms of ventricular tachyarrhythmia onset. This study aimed to determine the patterns of initiation of ventricular fibrillation (VF) in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients along with associated electrocardiogram (ECG) parameters and clinical characteristics. Methods:Examination of stored electrograms enabled us to evaluate the rhythm preceding each episode of VF and to calculate (intracardiac) ECG parameters including QT, QT peak (QTp), coupling interval, and prematurity index. Results:Sixty episodes of VF among 29 patients (mean age 64.4 ± 2.5 years) were identified. A single ventricular premature complex (VPC) initiated 46 (77%) episodes whereas a short-long-short (SLS) sequence accounted for 14 (23%) episodes. Of the 29 patients studied, 23 patients had VF episodes preceded by a VPC only, two patients with SLS only, and four patients with both VPC and SLS-initiated episodes. There were no significant differences between initiation patterns in regards to the measured ECG parameters; a faster heart rate with SLS initiation (mean RR prior to VF of 655 ± 104 ms for SLS and 744 ± 222 ms for VPC) approached significance (P = 0.06). The two patients with SLS only were not on ,-blockers compared to 83% of the VPC patients. Conclusion:Ventricular fibrillation is more commonly initiated by a VPC than by a SLS sequence among the MADIT II population. Current pacing modes designed to prevent bradycardia and pause-dependent arrhythmias are unlikely to decrease the incidence of VPC-initiated episodes of VF. [source] | ||||||||||||||||||||||||||||