Home About us Contact
|
Home About us Contact | ||
|
|
||
Median Change (median + change)
Selected AbstractsEvaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycineINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2006KOBAYASHI YASUYUKI Aim: We evaluated the functions of an affected kidney after laparoscopic partial nephrectomy (LPN) using renal scintigraphy with 99mtechnetium-mercaptoacetyltriglycine (99mTc-MAG3). Methods: Split renal function of 10 patients who underwent LPN for renal tumors was assessed using renal scintigraphy with 99mTc-MAG3 before surgery, and 1 week and 3 months post-surgery. Results: Median operating time was 196.5 min, median tumor diameter was 2.3 cm, mean blood loss was 64 mL and mean ischemic time was 38.5 min. Median change in serum creatinine level pre- to post-surgery was 0.15 mg/dL. Median contribution of the affected kidney to total renal function (calculated using 99mTc-MAG3) was 50.0%, 41.7% and 36.1% before surgery, 1 week and 3 months after LPN, respectively. In one patient, the tumor was resected after cooling of the affected kidney with ice slush for 15 min, and the split renal function ratio remained as high as 50% at 3 months post-operatively despite a total ischemic time of 61 min. Conclusions: This paper evaluated renal function on the affected side before and after surgery by measuring split renal function with renal scintigraphy using 99mTc-MAG3. Risk factors for renal dysfunction in the affected kidney after LPN include age over 70 years with more than 30 min warm ischemic time, re-clamping of the renal artery procedure, and a warm ischemic time greater than 60 min. We believe that renal cooling with slush ice prevents renal dysfunction of the affected kidney after LPN with longer warm ischemic times. However, an easier renal cooling technique should be sought for regular use of cooling procedures in LPN. [source] Isolated liver transplantation in infants with end-stage liver disease due to short bowel syndrome,LIVER TRANSPLANTATION, Issue 7 2006Jean F. Botha Infants with short bowel syndrome (SBS) and associated liver failure are often referred for combined liver/intestinal transplantation. We speculated that in some young children, nutritional autonomy would be possible with restoration of normal liver function. Features we believed to predict nutritional autonomy include history of at least 50% enteral tolerance, age less than 2 yr, and no underlying intestinal disease. This report documents our experience with liver transplantation alone in children with liver failure associated with SBS. Twenty-three children with SBS and end-stage liver disease, considered to have good prognostic features for eventual full enteral adaptation, underwent isolated liver transplantation. Median age was 11 months (range, 6.5 to 48 months). Median pretransplant weight was 7.4 kg (range, 5.2 to 15 kg). All had growth retardation and advanced liver disease. Bowel length ranged from 25 to 100 cm. Twenty-three children underwent 28 isolated liver transplants. There were 14 whole livers and 14 partial grafts (five living donors). Seventeen patients are alive at a median follow-up of 57 months (range, 6 to 121 months). Actuarial patient and graft survival rates at 1 yr are 82% and 75% and at 5 yr are 72% and 60%, respectively. Four deaths resulted from sepsis, all within 4 months of transplantation, and 1 death resulted from progressive liver failure. Two allografts developed chronic rejection; both children were successfully retransplanted with isolated livers. Of 17 surviving patients, three require supplemental intravenous support; the remaining 14 have achieved enteral autonomy, at a median of 3 months (range, 1 to 72 months) after transplantation. Linear growth is maintained and, in many, catch-up growth is evident. Median change in z score for height is 0.57 (range, ,4.47 to 2.68), and median change in z score for weight is 0.42 (range, ,1.65 to 3.05). In conclusion, Isolated liver transplantation in children with liver failure as a result of SBS, who have favorable prognostic features for full enteral adaptation, is feasible with satisfactory long-term survival. Liver Transpl 12:1062,1066, 2006. © 2006 AASLD. [source] Long-term results of cataract surgery with implantation of a mechanically, reversibly adjustable intraocular lens: *Acri.Tec AR-1 PC/IOLACTA OPHTHALMOLOGICA, Issue 2008CE JAHN Purpose To investigate long-term safety and function of a mechanically, reversibly adjustable intraocular lens in human eyes Methods Clinical long-term monitoring of the initial 38 eyes of 38 patients with senile cataract after implantation of the *Acri.Tec AR-1 PC/IOL including a control group. Results Median follow-up was 25 (range 6 to 52 months). Throughout the entire period of observation all eyes were behaving clinically in the same way as if implanted with a conventionel PC/IOL. 2 eyes were adjusted surgically 2 weeks after implantation. 19/38 eyes underwent Nd:YAG laser capsulotomy after a median period of 12 (range 6 to 43) months after implantation. Median change of spherical equivalent between 1 month and the last visit was 0 (range , 0.5 to + 0.5) diopters. At the last visit median best visual acuity was 0.7 (range 0.2 to 1.0) for eyes with the *Acri.Tec AR-1 PC/IOL and 0.8( range 0.3 to 1.0) for the control group. Both eyes having undergone adjustment surgery had visual acuity of 0.8 rsp 1.0 with stable refractions 45 rsp. 42 months after adjustment surgery. Conclusion The *Acri.Tec AR-1 PC/IOL implanted into the capsular bag of adult human eyes is a safe PC/IOL. Refraction is predictably adjustable after implantation. It remains stable before and after Nd:YAG laser capsulotomy or after surgical adjustment of the refraction. This type of IOL may prove helpful especially in pediatric cataract surgery to avoid the development of amblyopia and in adults when precise refractive outcome is important either because of individual preference of the patient for a preferred refraction or because of intendend monovision to reduce spectacle dependence to a minimum. Commercial interest [source] Effect of simplification from protease inhibitors to boosted atazanavir-based regimens in real-life conditionsHIV MEDICINE, Issue 9 2010R Rubio Background Atazanavir (ATV) boosted with ritonavir (ATV/r) is a potent, well-tolerated, once-daily protease inhibitor (PI). Few data are available on this agent as a treatment simplification option for patients taking other PIs. Objective The aim of the study was to determine the effectiveness and safety of ATV-containing regimens in patients who have simplified their antiretroviral treatment. Methods SIMPATAZ was a multicentre, prospective, noninterventional study in patients who had undetectable HIV RNA on their current PI-containing therapy and who were switched to an ATV/r-based regimen. Patients underwent a routine physical examination, and data were collected on HIV RNA levels, CD4 cell counts, liver function, lipid parameters, adverse reactions, adherence to treatment and patient satisfaction. Results A total of 183 patients were enrolled in the study and included in the analysis (80% were male, 29% had AIDS, and 52% were coinfected with HIV and hepatitis B virus or hepatitis C virus). The median baseline CD4 count was 514 cells/,L. Median exposure to previous HIV therapy was 8 years, and 32% of patients had a history of PI failures. Lopinavir boosted with ritonavir was the most frequent PI replaced (62%) and tenofovir+lamivudine /emtricitabine the backbone most used during the study (29%). The study drug was discontinued early by 25 patients (14%), two of whom discontinued as a result of adverse events (Hodgkin lymphoma and vomiting). Two patients died (lung cancer and myocardial infarction). At month 12, 93% of the study population had an undetectable HIV RNA viral load. Hyperbilirubinaemia >3 mg/dL and increased alanine aminotransferase levels>200 IU/L were observed in 38.5% and 4.4% of patients, respectively. Median changes from baseline to month 12 in total cholesterol, triglycerides and low-density lipoprotein cholesterol were ,13 mg/dL (,7%; P<0.0001), ,19 mg/dL (,13%; P<0.0001) and ,7 mg/dL (,6%; P=0.021), respectively. Conclusions In a real-world setting, switching from other PIs to ATV/r is a well-tolerated and safe option for improving the lipid profile and for retaining virological response in controlled pretreated patients. [source] Does Simultaneous Antegrade and Retrograde Cardioplegia Improve Functional Recovery and Myocardial Homeostasis?JOURNAL OF CARDIAC SURGERY, Issue 5 2000F.E.T.C.S., M. J. Jasinski M.D. Methods: Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted. Results: In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group. Conclusions: Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone. [source] Treatment of Acute Stroke with Recombinant Tissue Plasminogen Activator and AbciximabACADEMIC EMERGENCY MEDICINE, Issue 12 2003Daniel C. Morris MD Objectives: Preclinical data suggest that treatment of acute ischemic stroke (AIS) with the combination of recombinant tissue plasminogen activator (rt-PA) and abciximab may increase efficacy and decrease the rate of symptomatic intracranial hemorrhage (sICH). The authors report pilot data of five AIS patients with half-dose rt-PA and abciximab as part of an ongoing phase I safety trial with sICH as the primary outcome. Methods: Five patients with AIS were treated with the combination of half-dose rt-PA (0.45 mg/kg) and abciximab (0.25 mg/kg bolus followed by a 0.125 ,g/kg/min infusion over 12 hours). Head computed tomographic scan was obtained after 24 hours of treatment onset. Results: Four patients received the combination of half-dose abciximab and rt-PA without major complications. One patient experienced a parenchymal hematoma type-1 ICH without significant decline of his neurological status. The average National Institutes of Health Stroke Scale change at discharge in comparison with pretreatment was ,5.4 ± 7.0, and the median change was 6 points with a range of 4 points (worsening) to ,13 points (improvement) (p = 0.07) based on a one-sided t-test. Conclusions: Administration of rt-PA and abciximab to AIS patients was completed without difficulty. No sICH were observed; however, 20% (1 out of 5) experienced an asymptomatic ICH. Based on our observation of five patients, there was a trend of treatment efficacy; however, these results need to be confirmed in a larger-scale placebo-controlled clinical trial. [source] A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failureJOURNAL OF CLINICAL NURSING, Issue 1 2008Timothy Kwok MD Aims and objectives., To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure. Design., Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs. Results., At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion., Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant. Relevance to clinical practice., Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken. [source] Improving clinical practice in stroke through audit: results of three rounds of National Stroke AuditJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2005P. Irwin BA RGN MSc Abstract Background, The results of three rounds of National Stroke Audit in England,, Wales and Northern, Ireland are, compared. Methods, Audit of the organization of stroke services and retrospective case-note audit of up to 40 consecutive cases admitted per hospital over a 3-month period was conducted in each of 1998, 1999 and 2001/02. The changes in the organizational, case-mix and process results of the hospitals that had participated in all three rounds were analysed. Results, 60% of all eligible trusts from England, Wales and Northern Ireland took part in all three audits in 1998, 1999 and 2001/02. Total numbers of cases were 4996, 4841 and 5152, respectively. Case-mix variables were similar over the three rounds. Mortality at 7 and 30 days fell by 3% and 5%, respectively. The proportion of hospitals with a stroke unit rose from 48% to 77%. The proportion of patients spending most of their stay in a stroke unit rose from 17% in 1998 to 26% in 1999 and 29% in 2001/02. Improvements achieved in process standards of care between 1998 and 1999 (median change was a gain of 9%) failed to improve further by 2001/02 (median change was 0%). In all three rounds process standards ,of ,care ,tended ,to ,be ,better ,in ,stroke units. Conclusions, Three rounds of national audit of stroke care have shown standards of care on stroke units were notably higher than on general wards. Slowing in the rise of the proportion managed on stroke units mirrors the slow down in improvement to overall national standards of care. To further improve outcomes and national standards of stroke care a much higher proportion of patients needs to be managed in stroke units. [source] Isolated liver transplantation in infants with end-stage liver disease due to short bowel syndrome,LIVER TRANSPLANTATION, Issue 7 2006Jean F. Botha Infants with short bowel syndrome (SBS) and associated liver failure are often referred for combined liver/intestinal transplantation. We speculated that in some young children, nutritional autonomy would be possible with restoration of normal liver function. Features we believed to predict nutritional autonomy include history of at least 50% enteral tolerance, age less than 2 yr, and no underlying intestinal disease. This report documents our experience with liver transplantation alone in children with liver failure associated with SBS. Twenty-three children with SBS and end-stage liver disease, considered to have good prognostic features for eventual full enteral adaptation, underwent isolated liver transplantation. Median age was 11 months (range, 6.5 to 48 months). Median pretransplant weight was 7.4 kg (range, 5.2 to 15 kg). All had growth retardation and advanced liver disease. Bowel length ranged from 25 to 100 cm. Twenty-three children underwent 28 isolated liver transplants. There were 14 whole livers and 14 partial grafts (five living donors). Seventeen patients are alive at a median follow-up of 57 months (range, 6 to 121 months). Actuarial patient and graft survival rates at 1 yr are 82% and 75% and at 5 yr are 72% and 60%, respectively. Four deaths resulted from sepsis, all within 4 months of transplantation, and 1 death resulted from progressive liver failure. Two allografts developed chronic rejection; both children were successfully retransplanted with isolated livers. Of 17 surviving patients, three require supplemental intravenous support; the remaining 14 have achieved enteral autonomy, at a median of 3 months (range, 1 to 72 months) after transplantation. Linear growth is maintained and, in many, catch-up growth is evident. Median change in z score for height is 0.57 (range, ,4.47 to 2.68), and median change in z score for weight is 0.42 (range, ,1.65 to 3.05). In conclusion, Isolated liver transplantation in children with liver failure as a result of SBS, who have favorable prognostic features for full enteral adaptation, is feasible with satisfactory long-term survival. Liver Transpl 12:1062,1066, 2006. © 2006 AASLD. [source] Rabbit antithymocyte globulin related decrease in platelet count reduced risk of pediatric renal transplant graft thrombosisPEDIATRIC TRANSPLANTATION, Issue 7 2006M. H. Kamel Abstract:, Graft thrombosis is a serious complication in pediatric renal transplantation. We assess a potential protective effect for the decrease in platelet count associated with RATG therapy against pediatric renal transplant graft vascular thrombosis. Between January 1986 and December 1998, 120 kidney transplants were performed in 95 pediatric recipients. Patients were divided into two groups. Group 1 (n = 61), non-RATG group received cyclosporine, azathioprine and steroids, while group 2 (n = 59), RATG group, received in addition, RATG at day 1 and continued for 4,10 days postoperatively. Platelet count prior to transplant, median change in absolute platelet count at 1 and 3 days post-transplant was recorded. Graft thrombosis incidence was examined. Six grafts (5%) developed thrombosis. All were in group 1 (p = 0.028). Median pretransplant platelet count (×109/L) in group 1 was 283 vs. 280 in group 2 (p = 0.921). Median decrease in absolute platelet count (×109/L) from pretransplant levels at one and three days post-transplant for group 1 and 2 was 18 vs. 83 (p , 0.001) and 39 vs. 105 (p , 0.001), respectively. Graft thrombosis risk factors were similar in both groups. RATG use was statistically significant (p = 0.044) for reduced risk of graft thrombosis in multivariate analysis. Patients receiving RATG showed significant decrease in both platelet count and graft thrombosis incidence. A role for RATG related effect on platelet count is assumed. [source] Acute increase in femoral artery resistance in response to direct physical stimuli in the human fetusBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2003Richard P. Smith Objective To determine whether fetal response to needling resembles the fetal ,brain sparing' response seen with hypoxaemia. Design Prospective observational study. Setting Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London. Population Eighty-five pregnant women undergoing invasive procedures associated with fetal prenatal diagnosis and/or management. Methods The femoral artery and the middle cerebral artery pulsatility index were measured by Doppler ultrasonography before and after 89 invasive procedures (fetal blood sampling, transfusion, bladder or cyst aspiration, shunt insertion and amniocentesis, between 17 and 36 weeks). Cases in which the fetal body was transgressed were compared with ,control' fetuses undergoing invasive procedures which did not directly involve needling the fetus (amniocentesis and placental cord insertion procedures). Main outcome measures Femoral artery and middle cerebral artery pulsatility index. Results The femoral artery pulsatility index rose after transgression [median change (,) 0.73; 95% confidence interval (CI) 0.51 to 0.98]. In contrast, there was no significant change in femoral artery pulsatility index after non-transgression procedures (mean , 0.28; 95% CI ,0.20 to 0.76). Analysis confirmed the fall in middle cerebral artery pulsatility index after transgression procedures (median ,,0.19; 95% CI ,0.07 to ,0.35), but there was also a significant fall in middle cerebral artery pulsatility index after non-transgression procedures (mean ,,0.47; 95% CI ,0.23 to ,0.71). Conclusions The human fetus mounts a peripheral haemodynamic response to invasive procedures involving transgression of the fetal body, which is consistent with the brain sparing effect. However, the change in middle cerebral artery pulsatility index in both transgression and control procedures suggests that the changes and mechanisms may be more complex than previously thought. [source] A pilot study on the use of wet wraps in infants with moderate atopic eczemaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2004P. E. Beattie Summary Wet wrap therapy (WWT) is a well-established treatment for severe atopic dermatitis (AD). However little evidence exists to justify widespread use in the community for less severe eczema. We compared the efficacy of WWT with a standard regime of hydrocortisone, to control moderate AD in children. We carried out a single-observer, randomized, controlled pilot study in 19 children under 5 years of age, with AD of 30% or more body surface area, using only 1% hydrocortisone (HC) prior to the study. Group one applied HC once in the morning for 2 weeks, with wet wraps twice daily for week 1, but only at night for week 2. Group two applied HC twice daily without wet wraps. Both applied emollient twice daily and as necessary. The primary outcome measure was the Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score, and the secondary outcome measures were the Infants Dermatology Quality of Life Index (IDQOL), the Dermatitis Family Impact (DFI) score and the weight of topical steroids and emollients used. Over the 2-week active therapy period the mean fall in SASSAD was 8 [95% confidence interval (CI), ,18 to +2; P = 0.11] more in the non-WWT group, the median change in the IDQOL was 2 for Group one and 7 for Group two (95% CI for difference, ,10 to +3; P = 0.24) and the median change in DFI score was 2 for Group one and 5 for Group two (95% CI for difference, ,14 to +2; P = 0.42). This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe, widespread AD, and provides weak evidence to suggest that it may be more effective. We would not advocate routine use of WWT for moderate eczema without further evaluation. [source] Trends in metals in urban and reference lake sediments across the United States, 1970 to 2001ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2006Barbara J. Mahler Abstract Trends in metals concentrations in sediment cores from 35 reservoirs and lakes in urban and reference settings were analyzed to determine the effects of three decades of legislation, regulation, and changing demographics and industrial practices in the United States on concentrations of metals in the environment. Decreasing trends outnumber increasing trends for all seven metals analyzed (Cd, Cr, Cu, Pb, Hg, Ni, and Zn). The most consistent trends are for Pb and Cr: For Pb, 83% of the lakes have decreasing trends and 6% have increasing trends; for Cr, 54% of the lakes have decreasing trends and none have increasing trends. Mass accumulation rates of metals in cores, adjusted for background concentrations, decrease from the 1970s to the 1990s, with median changes ranging from ,46% (Pb) to ,3% (Hg and Zn). The largest decreases are from lakes in dense urban watersheds where the overall metals contamination in recently deposited sediments has decreased to one-half its 1970s median value. However, anthropogenic mass accumulation rates in dense urban lakes remain elevated over those in lakes in undeveloped watersheds, in some cases by as much as two orders of magnitude (Cr, Cu, and Zn), indicating that urban fluvial source signals can overwhelm those from regional atmospheric sources. [source] Long-term efficacy and safety of adefovir dipivoxil for the treatment of hepatitis B e antigen,positive chronic hepatitis B,HEPATOLOGY, Issue 3 2008Patrick Marcellin Treatment of 171 patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with adefovir dipivoxil (ADV) 10 mg over 48 weeks resulted in significant histological, virological, serological, and biochemical improvement compared with placebo. The long-term efficacy and safety of ADV in a subset of these patients was investigated for up to 5 years. Sixty-five patients given ADV 10 mg in year 1 elected to continue in a long-term safety and efficacy study (LTSES). At enrollment, the 65 LTSES patients were a median 34 years old, 83% male, 74% Asian, 23% Caucasian, median baseline serum hepatitis B virus (HBV) DNA 8.45 log10 copies/mL, and median baseline alanine aminotransferase (ALT) 2.0 × upper limit of normal. At 5 years on study, the median changes from baseline in serum HBV DNA and ALT for the 41 patients still on ADV were 4.05 log10 copies/mL and ,50 U/L, respectively. HBeAg loss and seroconversion were observed in 58% and 48% of patients by end of study, respectively. Fifteen patients had baseline and end of follow-up liver biopsies; improvements in necroinflammation and fibrosis were seen in 67% and 60% of these patients, respectively. Adefovir resistance mutations A181V or N236T developed in 13 LTSES patients; the first observation was at study week 195. There were no serious adverse events related to ADV. Conclusion: Treatment with ADV beyond 48 weeks was well tolerated and produced long-term virological, biochemical, serological, and histological improvement. (HEPATOLOGY 2008;48:750,758.) [source] | ||||||||||