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At least 325 records · Page 18Linked to original sources
PubMed2003

Significance of the morphological patterns of electrograms recorded during ventricular fibrillation: an experimental study.

Mapping techniques are used to study the significance of the morphological patterns of the electrograms (EGMs) obtained during VF in an experimental model. In 24 isolated rabbit heart preparations recordings were made of activation during VF using a multiple electrode (121 unipolar electrodes) positioned on the lateral wall of the left ventricle. Three types of activation maps were selected: (A) with functional block of an activation front; (B) with epicardial breakthrough; and (C) with a single broad wavefront without block lines. The EGMs were classified as negative (Q), positive-negative with a predominance of the negative (rS) or positive wave (Rs), and positive (R). In 60 type A maps the morphology in the zone limiting the block line corresponded to an R wave in 55 (92%) cases and to Rs in 5 (8%) cases. In 67 type B maps, the EGM in the earliest activation zone most often showed Q wave morphology (48 [72%] cases), followed by rS (18 [27%] cases), and Rs morphology (1 [1%] case); in no case was R wave morphology seen. Finally, in 78 type C maps the morphology corresponded to a Q wave in 15 (19%) cases, rS in 38 (49%), Rs in 24 (31%), and R in a 1 (1%) case. The differences between the three types of maps were significant (P < 0.0001). Q wave EGM sensitivity for indicating the existence of an epicardial breakthrough pattern was 72%, with a specificity of 89%, and positive and negative predictive values of 76% and 87%, respectively. R wave EGM sensitivity for indicating the existence of conduction block was 92%, with a specificity of 99%, and positive and negative predictive values of 98% and 97%, respectively. R wave morphology is highly sensitive and specific for indicating conduction block. EGM recordings with initial positivity predominance are infrequent in the earliest activation zones of epicardial breakthrough during VF. The recording of the EGM with Q wave morphology indicates centrifugal activation from the explored zone.

Animals↗
PubMed2006

Small cell lung cancer.

Small cell lung cancer accounts for 13-15% of all lung cancer worldwide. There has been a decrease in the number of cases, with no clear explanation, except probably to changing in smoking habits in the last two decades. In the early eighties, it became clear that SCLC was an extremely sensitive tumor as to radiation as to chemotheraputic agents. With cisplatinum etoposide combinations or cyclophosphamide, anthracycline and vincristine/etyoposide regimens responses were observed in 50-70%, with 20-30% complete remissions in extensive disease. For limited stage patients chemotherapy associated with thoracic radiation was able to produce a cure rate of 10-20%. The addition of prophylactic brain irradiation to limited stage cases has reduced mortality by a factor of nearly 5%. But despite these early good results no breakthrough came later on, and in the last decade or so, we are still facing this plateau. New agents have recently been included in the therapeutic armamentarium, such as gemcitabine, irinotecan, paclitaxel. This fact has allowed many patients to receive a relatively active second line therapy, but the overall survival remains unchanged. Targeted therapies are undergoing some evaluations, but the data are too premature and so far quite discouraging. At the present time there is a urgent need to improve clinical research in this somehow forgotten disease.

Antineoplastic Agents↗
PubMed2004

Cost-effective strategies in the prevention of diabetic nephropathy.

A significant subgroup of patients with diabetes mellitus are predisposed to developing diabetic nephropathy and it is in this subgroup that other diabetes- related complications, and in particular greatly increased cardiovascular disease risk, are concentrated. The high personal, social and financial costs of managing end-stage renal failure and the other complications associated with diabetic nephropathy make a powerful case for screening and effective intervention programmes to prevent the condition or retard its progression. As major breakthroughs in finding genetic susceptibility factors remain elusive, screening efforts continue to be based on microalbuminuria testing, despite increasing recognition of its limitations as a positive predictor of nephropathy. Interventions have been extensively studied, but results remain conflicting. Economic evaluations of such screening and intervention programmes are essential for health planners, yet models of the cost/benefit ratio of such interventions often rely on a rather slim evidence base. Where economic models are developed, they are frequently based on those papers that propound the greatest clinical benefits of a given intervention, leading to a possible over-estimation of the advantages of the chosen approach. Furthermore, the benefits of even such generally accepted interventions as ACE inhibitor treatment are less firmly established than generally appreciated. Lifestyle interventions are instinctively attractive, but are by no means a low-cost option (as is often assumed by both medical professionals and politicians). This review critically assesses the evidence for clinical efficacy and economic benefit of microalbuminuria screening and interventions such as intensive glycaemic control, antihypertensive treatment, ACE inhibition and angiotensin receptor blockade, dietary protein restriction and lipid-modifying therapy. The various costs associated with diabetic nephropathy are so great that even expensive interventions may have a favourable cost/benefit ratio, provided they are truly effective.

Albuminuria↗
PubMed2003

Use of opioids in the treatment of severe pain in terminally ill patients--dying should not be painful.

Pain is a common symptom at the end of life. The vast majority of pain can be readily managed if simple principles of practice are followed. Chronic pain requires continuous analgesia, and severe pain requires use of strong analgesics, most commonly the opioids. In addition to drugs administered continually, short-acting medications must be available for "breakthrough" pain. This article reviews the principles of pain management in terminally ill patients, using a case-based demonstration.

Analgesia, Patient-Controlled↗
PubMed1999

Management of menstrual migraine.

Migraines may occur at any time during the menstrual cycle but are commonly associated with the menses. Migraine-specific medications, such as the triptans, may be effective for acute management of menstrual migraine. However, it is important to recognize the relationship between migraines and the menstrual cycle because these headaches may not respond to the usual antimigraine medications. In that case, management may involve perimenstrual migraine prophylaxis, with migraine-specific medications used in addition for severe breakthrough migraines. Prostaglandin inhibitors started just before the time of headache vulnerability may prevent menstrual migraine attacks or reduce the severity of the headaches. Estrogen withdrawal has been shown to precipitate migraine headaches, and a sustained elevated level of estrogen will postpone the migraine. Transdermal estrogen started just before menstruation can provide a sustained low level of estrogen, decreasing the degree of estrogen decline, and thus may prevent induction of migraines. Ergotamine tartrate is usually taken only for acute migraine, but may also be effective for prevention of menstrual migraine when used regularly once or twice per day during the time of risk. By understanding the underlying pathophysiology of the relationship between migraines and the menstrual cycle, the physician can successfully treat migraines associated with menses.

Female↗
PubMed2002

Intraocular lens and corneal status following aircraft ejection by a USAF aviator.

Prior to 1967, military aviators who developed visually significant cataracts that affected visual performance were grounded. Those that ultimately required surgical removal were permanently grounded because of significant optical effects post-operatively. With the advent of contact lenses, a limited number of aircrew were returned to the cockpit because of improved optical factors provided by contacts post-cataract surgery. However, development of the intraocular lens (IOL) in the 1970s marked a major technological breakthrough that provided the potential to restore post-cataract surgical vision to near normal conditions. This case report is the first known occurrence of ejection from a high performance militaryaircraft by an aviator with an IOL. The success and stability of the IOL through this event provided additional clinical and operational information relative to the overall USAF experience with certain types of IOL approved for use in USAF aircrew. The aviator also sustained unexpected corneal foreign bodies due to the canopy fragmentation system.

Adult↗
PubMed1990

[Induced labor for gravidae with low Bishop's scores (with report of 242 cases)].

In planned/selective delivery, gravidae with Bishop's score 5 or below 5 are deal with lower position water sac, the aim of which is to induce regular uterine contraction and complete physiological latent period of cervical dilation. From Oct 1986 to Dec 1988, 242 cases of primiparae by this method and the latent period in physiological limit. This is a great breakthrough in induced labour for gravidae with low Bishop's scores. We found that this method is simple, effective, safe, and economic. It not only alleviates pain of the gravidae, but also helps to prevent the rise of caesarean section rate.

Cervix Uteri↗
PubMed1995

[Classification of the site of the conduction disturbance in right bundle branch block using body surface mapping].

We can estimate the conduction disturbance in right bundle branch block (RBBB) using body surface mapping. Characteristics of body surface mapping in the cases with RBBB are classified into three types using the appearance time and the site of the breakthrough. In the first type, breakthrough appeared in the center of the anterior chest within the normal time. It shows the peripheral block of right bundle branch. In the second type, breakthrough appeared in the center of the anterior chest later than the normal time. It shows the conduction delay of the main trunk of right bundle branch. In the third type, breakthrough appeared at the left of the anterior chest later than the normal time. It suggests the complete block of the main trunk of right bundle branch.

Body Surface Potential Mapping↗
PubMed1993

[Intracranial angiomatous malformations].

During a four year period, 21 patients with intracranial arteriovenous malformations, and six with cavernous angiomas, were operated at Hvidovre Hospital. Of these, 16 had ruptured. There was one operative death, and five displayed normal perfusion pressure breakthrough during the post-operative course, one of these disabling. Radical surgery was performed in 21 cases, for the main part of the ruptured cases with ensuing good quality of life, and for the unruptured cases with elimination of the risk of bleeding, in addition to seizure control.

Adolescent↗
PubMed2005

Decision forest analysis of 61 single nucleotide polymorphisms in a case-control study of esophageal cancer; a novel method.

BACKGROUND: Systematic evaluation and study of single nucleotide polymorphisms (SNPs) made possible by high throughput genotyping technologies and bioinformatics promises to provide breakthroughs in the understanding of complex diseases. Understanding how the millions of SNPs in the human genome are involved in conferring susceptibility or resistance to disease, or in rendering a drug efficacious or toxic in the individual is a major goal of the relatively new fields of pharmacogenomics. Esophageal squamous cell carcinoma is a high-mortality cancer with complex etiology and progression involving both genetic and environmental factors. We examined the association between esophageal cancer risk and patterns of 61 SNPs in a case-control study for a population from Shanxi Province in North Central China that has among the highest rates of esophageal squamous cell carcinoma in the world. METHODS: High-throughput Masscode mass spectrometry genotyping was done on genomic DNA from 574 individuals (394 cases and 180 age-frequency matched controls). SNPs were chosen from among genes involving DNA repair enzymes, and Phase I and Phase II enzymes. We developed a novel adaptation of the Decision Forest pattern recognition method named Decision Forest for SNPs (DF-SNPs). The method was designated to analyze the SNP data. RESULTS: The classifier in separating the cases from the controls developed with DF-SNPs gave concordance, sensitivity and specificity, of 94.7%, 99.0% and 85.1%, respectively; suggesting its usefulness for hypothesizing what SNPs or combinations of SNPs could be involved in susceptibility to esophageal cancer. Importantly, the DF-SNPs algorithm incorporated a randomization test for assessing the relevance (or importance) of individual SNPs, SNP types (Homozygous common, heterozygous and homozygous variant) and patterns of SNP types (SNP patterns) that differentiate cases from controls. For example, we found that the different genotypes of SNP GADD45B E1122 are all associated with cancer risk. CONCLUSION: The DF-SNPs method can be used to differentiate esophageal squamous cell carcinoma cases from controls based on individual SNPs, SNP types and SNP patterns. The method could be useful to identify potential biomarkers from the SNP data and complement existing methods for genotype analyses.

Algorithms↗
PubMed1997

Jugular venous bulb oxygen saturation monitoring in arteriovenous malformation surgery.

We describe a case in which jugular venous bulb oxygen saturation (SjvO2) monitoring proved useful during the surgical resection of an intracranial arteriovenous malformation (AVM). Surgical resection of large intracranial AVMs may be followed by normal perfusion pressure breakthrough with brain swelling, hyperemia, and subsequent problems in achieving hemostasis. SjvO2 monitoring during AVM embolization by interventional radiology has been shown to help in deciding whether embolization is sufficient to avoid such postresection hyperemia, but its use during surgical resection has not been described. In the case discussed, SjvO2 monitoring enabled assessment of the risk of postresection hyperemia preoperatively and permitted the degree and completeness of surgical AVM resection to be followed intraoperatively. During the normal perfusion pressure breakthrough bleeding which followed complete AVM resection, SjvO2 monitoring helped with safe management of the controlled hypotension that finally permitted hemostasis to be achieved.

Adult↗
PubMed2006

Attenuation of aqueous benzene in soils under saturated flow conditions.

The fate of aqueous benzene in subsurface was investigated in this study, focusing on the role of sorption and biodegradation on the benzene attenuation under dynamic flow conditions. Two sets of column tests were conducted in Plexiglass flow cells packed uniformly with sandy aquifer materials. The first set of the experiment was conducted with a step-type injection of benzene with different powder activated carbon (PAC) contents: (1) PAC = 0 %; (2) PAC = 0.5 %; (3) PAC = 2.0%. The second set was performed as a pulse-type with different test conditions: (4) benzene; (5) benzene and bacteria (Pseudomonas aeruginosa); (6) benzene and bacteria (P. aeruginosa) with hydrogen peroxide. In addition, numerical experiments were performed to examine the role of sorption processes on the benzene attenuation. In the step mode experiments, the KCl breakthrough curves (BTCs) reached the input concentration while the benzene BTCs were considerably lower than those of KCl with slight retardation for all cases, indicating that both reversible/retardation and irreversible sorption occurred. The pulse type tests showed that attenuation of benzene increased in the presence of bacteria due to biodegradation. The benzene attenuation by microbial degradation increased furthermore in the presence of hydrogen peroxide owing to sufficient supply of dissolved oxygen in soil column. Numerical experiments demonstrated that retardation could not contribute to the attenuation of benzene in soils but could only extend its breakthrough time. Experimental results indicated that aqueous benzene could be attenuated by irreversible sorption and biodegradation during transport through the subsurface. Additionally, the attenuation of aqueous benzene is closely related to organic carbon content and oxygen level existing in contaminated aquifers.

Adsorption↗
PubMed1998

Prognosis: wired. Why Internet technology is the next medical breakthrough.

One observer calls it "e-mail on steroids." Whizzing along the Internet and encrypted against hacking, clinical messaging lets doctors consult on tough cases, speed up test results, even chat with their patients. So why aren't these systems widely used? Blame politics, not the technology.

Attitude of Health Personnel↗
PubMed2006

[Acute abdomen due to a right-sided strangulated traumatic diaphragmatic hernia. Case report].

Traumatic rupture of diaphragm is sometimes diagnosed many years after the traumatic event. Due to the silent nature of diaphragmatic injuries, the diagnosis is easily missed or difficult. We describe a rare case of right diaphragmatic hernia, in which the diagnosis was made many years after the trauma. The incidence of right diaphragmatic hernia is about 11-14% of all diaphragmatic hernias. The patient showed acute hernia of the small intestine and was treated with resection of the intestinal loop and repair of breakthrough by suture. The diagnosis was made with a standard X-ray of thorax and abdomen. CT scan and NMR give more accurate information in these cases. The surgical repair is the treatment of choice in all traumatic diaphragmatic hernias.

Abdomen, Acute↗
PubMed2006

[Family observation of Kawasaki disease: 2 cases in sister and brother].

This article presents the clinical observation of 2 cases of children suffering from Kawasaki disease in the same family at a 7-year interval. This observation suggests a genetic predisposition to the disease. Epidemiological surveys conducted in Japan for some years point to a genetic factor but without proof. Childhood systemic febrile vasculitis is hard to recognise, so its diagnosis is often made lately, while there is an effective therapy, which prevents from serious cardiovascular complications. Identification of its precise cause, a necessary step before any diagnostic laboratory test, will be a major breakthrough.

Female↗
PubMed1991

Solitary cerebral metastasis from lung cancer with very long survival: report of two cases and review of the literature.

Solitary cerebral metastases from lung cancer are not uncommon clinical events. Whatever treatment is adopted, long-term survival is rare. Very rare indeed are reports of patients surviving the discovery of lung cancer and brain metastasis for 10 years or more. Indeed, only 16 cases have been reported to our knowledge. We report two further cases, stressing the importance of correct clinicopathological staging so that treatment may be conducted in the way most likely to ensure longer and better survival and, pending a therapeutic breakthrough, to increase the number of long-term survivors.

Adenocarcinoma↗
PubMed2002

Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt.

OBJECTIVES: To evaluate the quality of care delivered to children with epilepsy and study the predictors of seizure recurrence after initial control. DESIGN: A cross-sectional study was conducted during 4-month period (1 January to 30 April 1999). SETTING: Children's hospitals providing out-patient and in-patient services to the majority of children in Alexandria, Egypt. OUTCOME: Seizure recurrence after at least 6 months from anti-epileptic drug (AED) adjustment. RESULTS: Electroencephalogram was performed in 82.1% of cases, whereas plasma assay was performed in only 7% of cases. AEDs were initiated after the first seizure rather than the first recurrence of seizure. Carbamazepine was the most frequently prescribed drug, followed by valproate, except for generalized absence type, which was mainly managed by valproate. Suboptimal quality of care consisted mainly of poor diagnostic assessment of children with epilepsy, underuse of plasma monitoring for AED levels, unjustified use of oral AEDs during breakthrough fits, and defective health education to the caregivers of children with epilepsy that was manifested by non-compliance with AEDs in 30.1% of cases. The outcome of the current healthcare was a 71.6% recurrence of seizures after initial control. Continuous seizures before treatment, a polytherapy regimen, and non-compliance with management procedures were significant predictors for seizure recurrence. CONCLUSIONS: More specialized neurological care and health education programs for the caregivers of children with epilepsy are warranted. By exploring the details of medical practice, a foundation is provided upon which to build a quality improvement program, using the parameters in our study as an initial framework.

Adolescent↗
PubMed2002

Frequency and clinical significance of bloodstream infections caused by C albicans strains with reduced susceptibility to fluconazole.

Reduced susceptibility to fluconazole (RSF) is relatively common in non-albicans Candida isolates and in Candida albicans recovered from HIV-infected patients with relapsing Candida stomatitis or esophagitis. However, little clinical data on bloodstream infections caused by C. albicans with RSF is available. We analyzed 116 episodes of C. albicans fungemia detected over an 11-year period. Four patients (3.4%) had a blood isolate of C. albicans with RSF. Fluconazole MICs were 16 (3 SDD strains) and 128 microg/ml (1 resistant strain), respectively. Three of the patients were HIV (+) and the fourth was a liver transplant recipient. All of them had been previously treated with an azole compound. The liver recipient had breakthrough fungemia while being treated with 400 mg of preemptive fluconazole despite having an MIC of 16 microg/ml. Fluconazole clinical failure was documented in two of the remaining three cases. Only five other patients with C. albicans fungemia caused by fluconazole-resistant strains (>or=64 microg/ml) are described in the literature. Candida albicans fungemia produced by strains with RSF is still uncommon. It should be suspected in patients previously treated with azole agents or with breakthrough fungemia. In our experience, fluconazole remains a safe option for the treatment of most C. albicans fungemias, although surveillance seems advisable.

Antifungal Agents↗