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PubMed2000

Quantitative ultrasound in postmenopausal osteoporosis.

Ultrasound has been proposed as a low-cost, radiation-free method for osteoporosis assessment in postmenopausal women. Large prospective studies have shown that ultrasound parameters can be used for fracture risk estimate in this population, providing that adequate quality control is performed. The places of both ultrasound and the current gold standard method for bone assessment, dual energy x-ray absorptiometry, are still to be determined. Further studies are needed on the diagnosis of osteoporosis using ultrasound, because current diagnostic thresholds, designed by the World Health Organization, do not apply to this-new technology. Monitoring of skeletal changes and treatment effects by ultrasound cannot be recommended.

Absorptiometry, Photon↗
PubMed2003

Osteoporosis considerations in the frail elderly.

Osteoporosis is a growing public health problem throughout the world, in part because of the increasing numbers of people living beyond the age of 65 years. Skeletal fractures are the clinical manifestation of the disease, with older patients the most severely affected. Conditions associated with frailty such as falls and reduced muscle strength likely contribute to fractures, causing substantial mortality, morbidity, and economic cost. Screening guidelines for osteoporosis have been issued recently and take into account multiple risk factors for this condition. Falls are the chief mechanism by which osteoporotic fractures occur. Nonpharmacologic interventions for osteoporosis mainly address fall and frailty prevention, whereas pharmacologic interventions target bone loss through decreasing bone resorption, increasing bone formation, or a combination of both processes. Although guidelines for intervention strategies are in flux, it is now suggested that absolute fracture risk rather than diagnostic thresholds be used to determine the timing for therapeutic intervention. Individual risks and benefits of therapies need to be considered before choosing a therapeutic regimen.

Aged↗
PubMedDate not supplied

Platelet supersensitivity to thrombin stimulation in depression: a possible mechanism for the association with cardiovascular mortality.

The mortality risk associated with cardiovascular disease is significantly increased in patients with major depression and panic disorder. The mechanism of this phenomenon is unclear. Thrombin is responsible for platelet aggregation and shape change, and it plays a significant role in the development of thromboembolic events. In this study, we examined the platelet second messenger intracellular calcium response to thrombin stimulation in patients with major depression (n = 13), major depression after response to electroconvulsive therapy (ECT; n = 13), subsyndromal depression (n = 16), schizophrenia (n = 15), and control subjects (n = 65). Patients with major depression had significantly higher intracellular calcium responses to thrombin stimulation than control subjects, patients with subsyndromal depression, and patients with schizophrenia (p < 0.05). Electroconvulsive therapy did not significantly change this supersensitivity. This suggests that the platelet response to activation in patients with major depression is supersensitive. This study suggests a possible mechanism for the increased risk of cardiovascular disease that is seen in these two psychiatric disorders. The lack of difference between the control and subsyndromal depression groups appears to validate current diagnostic thresholds in depression. The failure of nonpharmacologic treatment to alter this marker suggests that it may be a trait marker of depression.

Adolescent↗
PubMed2002

Anxiety, affect, and activity in teenagers: monitoring daily life with electronic diaries.

OBJECTIVE: The everyday experiences of a community sample of adolescents differing in anxiety level were compared by means of electronic diaries. METHOD: One hundred fifty-five ninth-grade adolescents completed electronic diaries every 30 minutes for two 4-day intervals, reporting their moods, activities, social settings, dietary intake, smoking, and alcohol use. Teenagers were stratified into low-, middle-, or high-anxiety groups on the basis of diary ratings and, separately, questionnaire scores. RESULTS: High-anxiety teenagers, compared with low-anxiety teenagers, expressed higher levels not only of anxiety and stress but also of anger, sadness, and fatigue, along with lower levels of happiness and well-being. They reported fewer conversations and less recreational activity relative to achievement-oriented pursuits, stronger eating and smoking urges, and more tobacco use. There were few gender differences. Despite a tendency to spend less time with peers, high-anxiety teenagers were more likely to show reduced anxiety when in the company of friends. Sharper differentiations among anxiety subgroups emerged when stratification was based on diary reports rather than on questionnaire scores. CONCLUSION: Even when anxiety problems fall below diagnostic thresholds, the daily lives of anxious adolescents differ meaningfully from those of their peers in affective, behavioral, and contextual domains.

Activities of Daily Living↗
PubMed1993

Comorbidity of anxiety, phobia, compulsion and depression.

The longitudinal association of several syndromal diagnoses is very frequently a direct consequence of modern descriptive diagnosis. Comorbidity in this sense is clinically relevant. Comorbid cases are more severe, are more amenable to treatment and are more frequently suicidal. The level of association between psychiatric syndromes can lead to nosologic hypotheses that can be further examined by independent investigations, and especially by means of family studies. Generalized anxiety disorders are very closely associated with the affective disorders, particularly with depressions and suicide attempts, but also with hypomania. There is no close relationship with panic disorder. Social phobias are highly associated with agoraphobia, but also with simple phobia; also with panic, obsessive-compulsive syndromes and substance abuse. The prevalence of obsessive-compulsive syndromes depends to an exceptional degree on the definition. Syndromes below the diagnostic threshold of DSM-III are extremely frequent, and longitudinally a fluctuation about this threshold is apparent. OCS are especially found to be associated with social phobia and agoraphobia as well as with dysthymia and recurrent brief depression, but less with major depression.

Adult↗
PubMed2006

Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom.

OBJECTIVE: To investigate current practice in the diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg among orthopedic surgeons in the United Kingdom. DESIGN: Questionnaire survey. SETTING: Secondary care (NHS and private). PARTICIPANTS: Two hundred six orthopedic surgeons affiliated with one of the following specialist associations: British Association of Sports and Exercise Medicine (BASEM), United Kingdom Association of Doctors in Sport (UKADIS), British Orthopedic Sports and Trauma Association (BOSTA) and British Orthopedic Foot Surgery Society (BOFSS). INTERVENTIONS: Self-administered questionnaire. MAIN OUTCOME MEASURES: Current practice in diagnosis and treatment of CECS. RESULTS: Sixty percent (124/206) of the surveyed population replied and 53% (66/124) see patients with CECS. To confirm the diagnosis, 83% (55/66) use intra-compartmental pressure measurements (ICPs). Of these, 42% use maximal ICP during exercise greater than 35 mmHg as a criterion for anterior CECS diagnosis and 35% use Pedowitz's modified criteria. Of all the respondents, 88% would be willing to adopt a National Framework document for diagnosis, 30% (20/66) always try conservative treatment following diagnosis, 93% (57/60) perform superficial fasciotomy as the first line surgical procedure, 55% (33/60) use a one incision technique for anterior fasciotomy and 60% (36/60) undertake a repeat fasciotomy following failed decompression. CONCLUSIONS: There is agreement among orthopedic surgeons on the role of ICPs for diagnosis and the choice of fasciotomy as a first-line surgical procedure. In contrast, there is a divergence of opinions regarding the ICP diagnostic thresholds, the role of conservative management and the surgical techniques for fasciotomy and failure of decompression.

Athletic Injuries↗
PubMed2004

Comparability of telephone and face-to-face interviews in assessing patients with posttraumatic stress disorder.

INTRODUCTION: Structured clinical interviews are very important in the area of mental health research and services. Prior research comparing the reliability and validity of face-to-face and phone interviews has found high levels of agreement. This project compared the results of face-to-face and phone interviews for two widely used measures: The Clinician-Administered PTSD Scale (CAPS) for assessing posttraumatic stress disorder diagnostic status and symptom severity and the Hamilton Rating Scale for Depression (Ham-D) to determine the severity of major depressive disorder. METHOD: Subjects were 34 veterans recruited from applicants to the PTSD Assessment and Intervention program at the Cincinnati VA Medical Center. Order of interview (in-person or phone) was determined using random assignment within a counterbalanced framework. After attaining satisfactory levels of interrater reliability, four clinicians independently and blindly evaluated the subjects. RESULTS: Pearson correlation coefficients between face-to-face and phone interviews revealed high consistency (CAPS r = 0.745, HAM-D r = 0.748). The level of agreement between the two methods was 82% for the CAPS and 85% for the HAM-D. Diagnostic thresholds for the CAPS and HAM-D, after adjusting for the interview order and time elapsed between interviews, did not differ between the two groups (p = 0.31 for the CAPS and p = 0.96 for the HAM-D). High levels of agreement were achieved between the two methods (kappa = 0.75 for the CAPS using a cutoff of 65 and 0.70 for the HAM-D). The high sensitivity, specificity, and predictive values support the reliability of the phone-interview method. CONCLUSION: Phone interviews are a reliable method of interviewing for use in assessing patients for posttraumatic stress disorder and major depressive disorder.

Aged↗
PubMed2004

Accuracy of delayed (24 hours) processing of bronchoalveolar lavage for diagnosing bacterial pneumonia.

OBJECTIVE: Pneumonia in the intensive care unit is associated with a high mortality rate. Diagnostic accuracy is mandatory to improve prognosis. However, in many hospitals, samples from the respiratory tract cannot be immediately processed bacteriologically around the clock. This may complicate therapeutic choice based on invasive diagnostic procedures. We evaluated the effect of storing bronchoalveolar lavage fluid at 4 degrees C for 24 hrs on direct examination and culturing for diagnosing pneumonia. DESIGN: Prospective, paired comparison study. SETTING: Intensive care unit in a university hospital. PATIENTS: A total of 93 bronchoalveolar lavages were performed on 66 intensive care unit patients who were suspected to have bacterial pneumonia. INTERVENTION: Each sample was divided into two; one half was processed immediately (H0), and the other was processed after refrigeration at 4 degrees C for 24 hrs (H24). MEASUREMENTS AND MAIN RESULTS: All negative H0 culture samples (n = 31) were also negative for pathogens in H24 samples. Sixty two bronchoalveolar lavage cultures yielded one or more microorganisms, giving a total of 113 microorganisms in one or both samples. The results of positive cultures at H0 and H24 for the culturing diagnostic threshold of 10 colony forming units/mL agreed well (Kappa coefficient, 0.84); agreement was even better (Kappa coefficient, 0.85) when possible contaminants were excluded. The bias calculated as the mean difference between paired culture results was 0.195 +/- 1.31 (Delta log). When considering the accepted threshold of 10 colony forming units/mL, specificity at H24 compared to H0 was excellent (100%), but sensitivity was slightly lower (80%). CONCLUSION: Delayed processing of bronchoalveolar lavage sampling is an acceptable alternative when immediate culturing cannot be performed because it enables antibiotic administration.

Bronchoalveolar Lavage Fluid↗
PubMed2005

Hepatic copper in patients receiving long-term total parenteral nutrition.

GOALS: To assess the possibility of iatrogenic hepatic copper overload in adult patients on long-term total parenteral nutrition (TPN). BACKGROUND: TPN predisposes to hepatic copper accumulation through disturbances of the enterohepatic bile acid pool, but iatrogenic copper overload through TPN solutions may occur as well. STUDY: Quantitative hepatic copper and multiple clinical, biochemical, and histopathologic parameters were compared between patients with long-term TPN associated liver disease (n = 28) and patients with drug-induced cholestatic liver disease (n = 10). RESULTS: Eighty-nine percent of TPN patients and all controls had mildly elevated hepatic tissue copper, but 29% of TPN patients had levels above the diagnostic threshold for Wilson's disease. Quantitative hepatic copper correlated positively with serum aspartate aminotransferase (P = 0.001, r = 0.59), total bilirubin (P < 0.001, r = 0.65), and direct bilirubin (P < 0.001, r = 0.63) in TPN patients, but not in controls. The amount of hepatic copper did not correlate with the duration of TPN (median, 1.9 years; range, 0.3-18.0 years) or serum copper levels. TPN patients with significant cholestasis accumulated more copper than patients with no or only minimal cholestasis (P = 0.002). CONCLUSIONS: Significant hepatic copper overload in TPN patients occurs through chronic cholestasis in TPN-associated liver disease and is independent from the total duration of TPN. Iatrogenic copper overload through trace elements in TPN solutions does not seem to be a significant factor.

Adolescent↗
PubMedDate not supplied

Obesity, diabetes, and risk of cardiovascular disease in the elderly.

There is an age-related increase in total body fat and visceral adiposity until age 65 years that often is accompanied by diabetes or impaired glucose tolerance. The prevalence of type 2 diabetes increases progressively with age, peaking at 16.5% in men and 12.8% in women at age 75-84 years. Over age 65, diabetes or glucose intolerance was present in 30%-40% of Framingham Study subjects. There has been an alarming increase, of epidemic proportions, in both obesity and diabetes in the general population. Type 2 diabetes and obesity are both associated with a clustering of atherogenic risk factors, and when three or more are present it generally signifies an insulin resistance syndrome. This is promoted by weight gain and visceral adiposity. The risk of macrovascular disease is increased before glucose levels reach the diagnostic threshold for "diabetes," and 25% of newly diagnosed diabetics already have overt cardiovascular disease. In the Framingham Study, increased risk of cardiovascular disease was two-fold in men and three-fold in women, eliminating the female advantage over men for all outcomes except stroke. Coronary disease is the most common and lethal sequela, and unrecognized myocardial infarctions are three times more common in diabetic than nondiabetic men. Following a myocardial infarction, diabetes imposes a high rate of recurrence, heart failure, and death, more so in women than men. The risk of cardiovascular sequelae in diabetics is variable, the majority of events occurring in those with two or more additional risk factors. Because of the variable risk of cardiovascular disease in either the diabetic or obese person, risk stratification is necessary to determine the hazard of impending cardiovascular disease. This is readily accomplished with Framingham cardiovascular risk formulations. For persons with diabetes or obesity, the chief goal is to avoid the common cardiovascular sequelae. Comprehensive care should include not only normalization of the blood sugar, but also weight reduction, dietary fat restriction, strict blood pressure and lipid control, exercise, and avoidance of tobacco. Trial data indicate that preventive measures benefit obese diabetics even more than nondiabetics.

Adult↗
PubMed2005

Elevated late-night salivary cortisol levels in elderly male type 2 diabetic veterans.

OBJECTIVE: Late-night salivary cortisol (LNSC) is reportedly highly accurate for the diagnosis of Cushing's syndrome (CS). However, diagnostic thresholds for abnormal results are based on healthy, young populations and limited data are available on its use in elderly populations with chronic medical conditions. The purpose of this study was to evaluate LNSC levels in elderly male veterans with and without diabetes. DESIGN: Prospective evaluation of LNSC levels in male veterans. PATIENTS: One hundred and fifty-four participants with type 2 diabetes and 52 participants without diabetes. MEASUREMENTS: Participants underwent outpatient LNSC (2300 h) testing. Participants with elevated LNSC (> or = 4.3 nmol/l) underwent secondary testing, including 24-h urine free cortisol (24UFC, > 60 microg/day) and dexamethasone suppression testing (DST, serum cortisol > 50 nmol/l). Participants with positive secondary testing had a morning ACTH level analysed and either pituitary or adrenal imaging performed. RESULTS: One hundred and forty-one diabetics and 46 controls (mean age 61 years) returned samples (91% overall). Average LNSC levels (nmol/l) in diabetics were significantly higher than in nondiabetics [median (interquartile range): 2.6 (1.8-4.1) vs. 1.6 (1.0-2.0)] and in those aged > or = 60 compared to < 60 [2.7 (2.0-4.3) vs. 1.9 (1.4-2.9)] (P < 0.001 for both). Thirty-one participants required secondary testing. Seventy-nine per cent of participants who underwent secondary testing had normal 24UFC and DST. No cases of CS have been diagnosed to date. Increasing age [odds ratio (OR) 2.0 per decade], current diabetes mellitus (OR 4.4), and elevated blood pressure (OR 1.3 per 10 mmHg increase in systolic blood pressure) were associated with abnormal LNSC results (P < 0.05 for each). CONCLUSIONS: LNSC has been shown to be sensitive and specific in diagnosing CS in certain high-risk populations, primarily the young and middle-aged. The development of age- and comorbidity-adjusted thresholds may be warranted for LNSC testing in elderly subjects and in those with significant comorbidity.

Aged↗
PubMed2005

Factors predicting the development of metabolic syndrome and type II diabetes against a background of hypertension.

BACKGROUND: The metabolic syndrome (MetS), predicting coronary heart disease (CHD), is a compound of risk factors including diabetes, obesity and hypertension. The relationship between the development of MetS, diabetes and CHD in patients with established hypertension is unclear. We hypothesized that patients with hypertension developing MetS are at increased risk of type II diabetes and CHD compared with patients who do not develop MetS. MATERIALS AND METHODS: We prospectively studied 284 patients (100 with existing/established MetS) with hypertension but without diabetes and CHD over 4 years. MetS and diabetes were diagnosed by the modified NCEP and ADA criteria, and CHD risk by the Framingham risk equation; all patients had annual fasting blood sampling. RESULTS: Over 4 years of follow up, 75 of the 184 patients (41%) initially free of MetS at baseline subsequently fulfilled the criteria for MetS. These patients (i.e. 'developing MetS') had higher baseline BMI, triglycerides and lower HDL cholesterol, with a higher calculated CHD risk (all P <or= 0.001) than those who did not develop MetS. The 4-year odds ratios of developing diabetes in the patients with established MetS (23%) and the patients developing MetS (13.3%) vs. the patients not developing MetS (3.7%, P < 0.001) were 7.8 (95% CI: 2.6-23.5) and 4.0 (95% CI: 1.2-13.4), respectively. CONCLUSIONS: Patients with hypertension developing MetS have an increased CHD risk and risk of developing type II diabetes even before fulfilling the criteria for MetS, and the former is comparable to patients with established MetS. These data suggest a high-risk phase not adequately identified by current diagnostic thresholds for MetS.

Adult↗
PubMed1997

Effect of temperature variation (22 degrees C-44 degrees C) on halothane and caffeine contracture testing in normal humans.

BACKGROUND: Malignant hyperthermia (MH) susceptibility is diagnosed using halothane-caffeine contracture testing of a muscle sample maintained at 37 degrees C. However, there has not been a systematic study that examines the effect of different temperatures on the response of normal muscle to halothane and caffeine. We hypothesized that altering bath temperature would modify the contracture responses. METHODS: We obtained muscle samples from 20 patients undergoing surgical procedures of the lower extremities. The samples were dissected into 245 bundles and the bundles were exposed to halothane 3% or incremental caffeine, according to the North American MH group protocol. Several bundles from each patient were simultaneously studied at four different temperatures (22 degrees C, 30 degrees C, 37 degrees C and 44 degrees C). Each bundle was studied at only one temperature, the muscle samples of 3 patients were simultaneously studied at all four temperatures for halothane and caffeine. RESULTS: Maximum contracture to caffeine (32 mM) was highest at 37 degrees C; however, at lower caffeine concentrations (2-4 mM), there was no consistent effect of temperature on contracture response. Likewise, temperature did not alter contracture responses to halothane. The extremes of temperature (22 degrees C and 44 degrees C) were associated with lack of twitch in response to electrical stimulation. For the bundles exposed to halothane at 22 degrees C, the absence of a twitch was associated with the presence of a contracture, although these were never above the diagnostic threshold. CONCLUSIONS: We conclude that temperature has little effect on responses of normal muscle to halothane and caffeine.

Aged↗
PubMed2005

Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?

BACKGROUND: Serum pancreatic lipase may improve the diagnosis of pancreatitis compared to serum amylase. Both enzymes have been measured simultaneously at our hospital allowing for a comparison of their diagnostic accuracy. METHODS: Seventeen thousand five hundred and thirty-one measurements of either serum amylase and or serum pancreatic lipase were made on 10 931 patients treated at a metropolitan teaching hospital between January 2001 and May 2003. Of these, 8937 were initially treated in the Emergency Department. These results were collected in a database, which was linked by the patients' medical record number to the radiology and medical records. Patients with either an elevated lipase value or a discharge diagnosis of acute pancreatitis had their radiological diagnosis reviewed along with their biochemistry and histology record. The diagnosis of acute pancreatitis was made if there was radiological evidence of peripancreatic inflammation. RESULTS: One thousand eight hundred and twenty-five patients had either elevated serum amylase and or serum pancreatic lipase. The medical records coded for pancreatitis in a further 55 whose enzymes were not elevated. Three hundred and twenty of these had radiological evidence of acute pancreatitis. Receiver operator characteristic analysis of the initial sample from patients received in the Emergency Department showed improved diagnostic accuracy for serum pancreatic lipase (area under the curve (AUC) 0.948) compared with serum amylase (AUC, 0.906, P < 0.05). A clinically useful cut-off point would be at the diagnostic threshold; 208 U/L (normal <190 U/L) for serum pancreatic lipase and 114 U/L (normal 27-100 U/L) for serum amylase where the sensitivity was 90.3 cf., 76.8% and the specificity was 93 cf., 92.6%. 18.8% of the acute pancreatitis patients did not have elevated serum amylase while only 2.9% did not have elevated serum pancreatic lipase on the first emergency department measurement. CONCLUSION: It is concluded that serum pancreatic lipase is a more accurate biomarker of acute pancreatitis than serum amylase.

Acute Disease↗
PubMed2006

Circulating tumour-associated plasma DNA represents an independent and informative predictor of prostate cancer.

OBJECTIVE: To investigate whether preoperative plasma levels of free DNA can discriminate between men with localized prostate cancer and benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: In all, 161 referred patients suspicious for prostate cancer either by an elevated prostate-specific antigen (PSA) level and/or abnormal digital rectal examination (DRE) were included in this prospective study. Peripheral plasma was taken before prostate biopsy and genomic DNA was extracted from the plasma using the a commercial kit and a vacuum chamber. After controlling for age, PSA level, the percentage free/total (f/t) PSA and prostate volume, the median prostate cancer plasma DNA concentration served as diagnostic threshold in uni- and multivariate logistic regression models. Multivariate models were subjected to 200 bootstraps for internal validation and to reduce over-fit bias. RESULTS: Subgroups consisted of 142 men with clinically localized prostate cancer and 19 with BPH. The median plasma concentration of cell-free DNA was 267 ng/mL in men with BPH vs 709 ng/mL in men with prostate cancer. In univariate analyses, plasma DNA concentration was a statistically significant and informative predictor (P = 0.032 and predictive accuracy 0.643). In multivariate analyses, it remained statistically significant after controlling for age, tPSA, f/tPSA and prostate volume, increasing the predictive accuracy by 5.6%. CONCLUSIONS: Our data suggest that plasma DNA level is a highly accurate and informative predictor in uni- and multivariate models for the presence of prostate cancer on needle biopsy. The predictive accuracy was substantially increased by adding plasma DNA level. However, larger-scale studies are needed to further confirm its clinical impact on prostate cancer detection.

Adult↗
PubMed2005

Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial.

AIMS: Most studies relating minor gestational metabolic alterations to macrosomia refer to glucose intolerance classified on the basis of the National Diabetes Data Group or previous World Health Organization diagnostic thresholds. Our aim was to evaluate the consequences of very mild forms of gestational glucose intolerance, defined by an elevated 50-g glucose challenge test followed by a normal oral glucose tolerance test, using the more restrictive Carpenter and Coustan's criteria (Borderline Gestational Glucose Intolerance, BGGI). METHODS: Three hundred BGGI women were randomly assigned to: Group A (standard management), Group B (dietary treatment and regular monitoring). A control group (C) was also considered. Newborns were classified as macrosomic, large (LGA), or small for gestational age (SGA). RESULTS: The three groups were similar in age, body mass index and parity. Therapy in Group B significantly improved fasting (from 4.68 +/- 0.45 to 4.28 +/- 0.45 mmol/l) and 2-h postprandial glycaemia (from 6.01 +/- 0.57 to 5.13 +/- 0.68 mmol/l). Fasting glycaemia at delivery was significantly lower in B (4.20 +/- 0.38 mmol/l) than in A (4.84 +/- 0.45 mmol/l), and was also lower than in C (4.31 +/- 0.39 mmol/l). Significantly fewer LGA babies were born to Group B (6.0%) than Group A (14.0%) and Group C (9.1%). No difference was found in the SGA rate. The neonatal Ponderal Index was higher (P = 0.030) in group A (2.73 +/- 0.35) than in C (2.64 +/- 0.30) and B (2.64 +/- 0.24). CONCLUSIONS: Even very mild alterations in glucose tolerance can result in excessive or disharmonious fetal growth, which may be prevented by simple, non-invasive therapeutic measures.

Adult↗
PubMed1991

Implantable cardioverter defibrillator: data storage and retrieval with Patientlog.

A pacemaker management system (Patientlog), implemented on a IBM personal computer (AT), was adapted for the control and the administrative management of patients with an implantable cardioverter defibrillator (ICD). Several parameters used for pacemakers were also suitable for ICDs, while some fields were defined within the available frame of the database, to cope with the specific technical information of ICDs. "Intervention-cards" display diagnostic (threshold) as well as complex surgical information (approach, lead systems, etc.). "Follow-up-cards" present charge time and the number of shocks in such a way that decision making is very easy. Fourteen patients were followed with a total of 21 interventions, six different types of devices, and more than 150 follow-ups. A correct control of ICD functions is easy. The system is adapted for programmable ICDs. Updated reports containing necessary information are generated immediately after each procedure or follow-up.

Database Management Systems↗
PubMed2005

Tilt testing: is it necessary in all patients with suspected vaso-vagal syncope?

BACKGROUND: Head-up tilt testing (HUTT) is a well-established diagnostic tool in patients with suspected vaso-vagal syncope (VVS). However, it is time-consuming and requires special equipment. Thus, identification of simple parameters which could predict the outcome of HUTT could simplify diagnostic steps by obviating the need for HUTT. AIM: To assess which symptoms associated with spontaneous syncope or other details from medical history can predict HUTT results. METHODS: The study group consisted of 202 unselected patients (69 males, mean age 43 +/- 20 years) who were admitted to our syncope unit for HUTT due to suspected VVS. They filled in a detailed questionnaire including 34 standard questions concerning medical history as well as circumstances and symptoms associated with syncopal episodes. Patients were tilted to 70 degrees for 45 minutes or the test was stopped earlier if syncope occurred. A stepwise multiple logistic regression was performed in order to assess which parameters independently predicted the results of HUTT. A point-score was developed by assigning +/-1, +/-2, or +/-3 points to each of the factors based on the relative magnitude of the estimated regression coefficient. The points were then summed and a diagnostic threshold chosen using plots of sensitivity and specificity curves. RESULTS: Syncope was induced by HUTT in 67 (33%) patients. In the whole study group, a point-score identified patients with positive HUTT with a sensitivity of 87.9%, and specificity of 36.3%. When the analysis was confined to the subgroup with >4 syncopal episodes in the past, the sensitivity of a point-score was 94.4%, and specificity--60%, and in the subgroup with >2 syncopal episodes occurring within 1 month preceding HUTT, sensitivity values reached 88.2% at the specificity level of 90.9%. CONCLUSIONS: In patients with frequent syncopal episodes, especially clustered shortly before performing HUTT, in whom symptoms are very suggestive of VVS, a simple point-score system based on medical history accurately predicts HUTT results. Thus, HUTT may not be necessary for establishing diagnosis in this group of patients.

Adult↗