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PubMedDate not supplied

Symptomatic scapulothoracic crepitus and bursitis.

Scapulothoracic crepitus and scapulothoracic bursitis are related painful disorders of the scapulothoracic articulation. Scapulothoracic crepitus is the production of a grinding or snapping noise with scapulothoracic motion, which may be accompanied by pain. Scapulothoracic bursitis manifests as pain and swelling of the bursae of the scapulothoracic articulation. Scapulothoracic bursitis is always seen in patients with symptomatic scapulothoracic crepitus, but may exist as an isolated entity. Symptomatic scapulothoracic crepitus may be due to pathologic changes in the bone or soft tissue between the scapula and the chest wall or may be due to changes in congruence of the scapulothoracic articulation, as seen in scoliosis and thoracic kyphosis. Treatment of patients with symptomatic scapulothoracic crepitus begins with nonoperative methods, including postural and scapular strengthening exercises and the application of local modalities. When soft-tissue lesions are the cause of scapulothoracic crepitus, conservative treatment is highly effective. When symptomatic scapulothoracic crepitus is due to osseous lesions, or when conservative treatment has failed, surgical options are available. Partial scapulectomies have produced satisfactory outcomes in selected patients. Recently, open and arthroscopic scapulothoracic bursectomies have been performed with some success and are being used more frequently.

Bursitis↗
PubMed2004

Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial.

BACKGROUND: The current standard initial therapies for deep venous thrombosis are low-molecular-weight heparin and unfractionated heparin. In a dose-ranging study of patients with symptomatic deep venous thrombosis, fondaparinux had efficacy and a safety profile similar to those of low-molecular-weight heparin (dalteparin). OBJECTIVE: To evaluate whether fondaparinux has efficacy and safety similar to those of enoxaparin in patients with deep venous thrombosis. DESIGN: Randomized, double-blind study. SETTING: 154 centers worldwide. PATIENTS: 2205 patients with acute symptomatic deep venous thrombosis. INTERVENTION: Fondaparinux, 7.5 mg (5.0 mg in patients weighing <50 kg and 10.0 mg in patients weighing >100 kg) subcutaneously once daily, or enoxaparin, 1 mg/kg of body weight, subcutaneously twice daily for at least 5 days and until vitamin K antagonists induced an international normalized ratio greater than 2.0. MEASUREMENTS: The primary efficacy outcome was the 3-month incidence of symptomatic recurrent venous thromboembolic complications. The main safety outcomes were major bleeding during initial treatment and death. An independent, blinded committee adjudicated all outcomes. RESULTS: 43 (3.9%) of 1098 patients randomly assigned to fondaparinux had recurrent thromboembolic events compared with 45 (4.1%) of 1107 patients randomly assigned to enoxaparin (absolute difference, -0.15 percentage point [95% CI, -1.8 to 1.5 percentage points]). Major bleeding occurred in 1.1% of patients receiving fondaparinux and 1.2% of patients receiving enoxaparin. Mortality rates were 3.8% and 3.0%, respectively. LIMITATIONS: Follow-up was incomplete in 0.4% of fondaparinux-treated patients and 1.0% of enoxaparin-treated patients. CONCLUSIONS: Once-daily subcutaneous fondaparinux was at least as effective (not inferior) and safe as twice-daily, body weight-adjusted enoxaparin in the initial treatment of patients with symptomatic deep venous thrombosis.

Aged↗
PubMed2004

Withholding anticoagulation after a negative result on duplex ultrasonography for suspected symptomatic deep venous thrombosis.

BACKGROUND: Negative results on simplified compression ultrasonography cannot rule out symptomatic deep venous thrombosis (DVT) without further testing, such as repeated ultrasonography several days later. Repeated testing is costly and inconvenient, and patients are sometimes less likely to return for follow-up tests. OBJECTIVE: To determine the rate of venous thromboembolism when anticoagulation is withheld in patients with symptoms of DVT of the leg after negative results on a single examination with comprehensive duplex ultrasonography. DESIGN: Prospective clinical cohort study. SETTING: Peripheral vascular laboratory of a tertiary care academic hospital. PATIENTS: 445 consecutive patients in whom a first episode of symptomatic DVT was suspected. INTERVENTION: The researchers examined the entire leg with comprehensive duplex ultrasonography, using compression and Doppler techniques. Anticoagulation was withheld from the group with negative results. Patients were observed for thromboembolic events for 3 months. MEASUREMENTS: All patients who had new or progressive symptoms or signs of venous thromboembolism during follow-up underwent objective testing. RESULTS: Comprehensive duplex ultrasonography yielded normal results in 384 patients (86.3%) and showed DVT in 61 patients (13.7%). Nineteen cases of DVT (31.1%) were isolated to the deep veins of the calf. Nine patients in the negative cohort (2.3%) were excluded from analysis because they received anticoagulation for reasons unrelated to venous thromboembolism. Three of 375 patients (0.80% [95% CI, 0.16% to 2.33%]) in the normal cohort had symptomatic venous thrombosis during the 3-month follow-up. All 384 patients in the negative cohort completed follow-up. LIMITATIONS: The study was conducted at a single tertiary care center by a peripheral vascular staff with substantial experience in duplex ultrasonography, which may limit the applicability of the results to other institutions. Pregnant patients were excluded. CONCLUSIONS: It is safe to withhold anticoagulation after negative results on comprehensive duplex ultrasonography in nonpregnant patients with a suspected first episode of symptomatic DVT of the leg. New or progressive symptoms should prompt further testing.

Adult↗
PubMed1976

Treatment of recurrent symptomatic ventricular tachycardia.

Eleven consecutive patients with recurrent ventricular arrhythmias were treated by an aggressive protocol and followed up prospectively. Arrhythmias, symptoms, and cardiac lesions were defined. Antiarrhythmic drugs were given on schedule, with blood levels determining dose; success or failure was defined by elimination or recurrence of symptomatic arrhythmias. When drug therapy failed, left ventricular aneurysmectomy was done when appropriate. Recurrent ventricular tachycardia was most frequently responsible for symptoms; coronary artery disease was the most frequent underlying disease. Symptomatic arrhythmias were eliminated in 8 of 11 patients (5 with drugs and 3 with aneurysmectomies), with a 16.5-month symptom-free average follow-up. An average of 2.9 therapeutic trials per patient was needed to control symptomatic arrhythmias. The average time from entry into the study until the start of ultimately effective therapy was 18 days. Therapy that eliminated symptoms did not eliminate all premature ventricular contractions, and occasionally even brief asymptomatic episodes of ventricular tachycardia persisted. Recurrent symptomatic ventricular arrhythmias can be controlled in many patients by rigorous application of current therapies.

Adult↗
PubMed1999

[Cerebral hemodynamics and risk for recurrent stroke in symptomatic internal carotid artery occlusion].

PURPOSE: In internal carotid artery occlusion, patients with inadequate blood supply relative to metabolic demand (misery perfusion) may be at increased risk for cerebral ischemia. This study investigated whether patients demonstrating misery perfusion on positron emission tomography (PET) have a high risk of subsequent stroke in symptomatic internal carotid artery occlusion. METHODS: We prospectively evaluated the relationship between the regional hemodynamic status of cerebral circulation and the subsequent risk of stroke in 40 patients with symptomatic internal carotid artery occlusion who underwent PET. Patients were divided into two hemodynamic categories according to the mean hemispheric value of oxygen extraction fraction (OEF) in the hemisphere supplied by the artery with symptomatic disease: patients with increased OEF and those with normal OEF. All patients were followed with medical treatment until the recurrence of stroke or death for 3 years. RESULTS: The three-year incidence of ipsilateral ischemic strokes for patients with normal OEF and those with increased OEF were 1 of 34 and 3 of 6 patients, respectively. A significantly higher incidence of ipsilateral strokes was found in patients with increased OEF (Kaplan-Meier analysis and log-rank test; p < 0.001). Multivariate analysis with the Cox proportional hazards model demonstrated that increased OEF significantly increased stroke recurrence: the relative risk was 19.5 (95% CI, 2.0-188.6) for ipsilateral stroke. An increase in the absolute OEF value was a better predictor of recurrent ischemic stroke than an OEF asymmetry. CONCLUSION: These findings suggest that patients with symptomatic internal carotid artery occlusion and misery perfusion have a high risk for subsequent stroke. Thus, identification and optimal treatment of patients with misery perfusion may be essential in preventing stroke.

Aged↗
PubMed1999

[Endovascular surgery for untreated ruptured aneurysm with symptomatic vasospasm].

It is difficult to treat ruptured aneurysms with symptomatic vasospasm. Although direct surgery for such cases is associated with poor outcomes, conservative therapy has the risk of both rerupture and infarction. In two cases of ruptured aneurysms with symptomatic vasospasm, we performed aneurysmal coil embolization with Guglielmi electrodetatchable coils (GDC). At the same time we performed percutaneous transluminal angioplasty (PTA) with papaverine infusion. In both cases, rerupture did not occur and PTA was effective angiographically. A good outcome was achieved in case 1. However, broad cerebral infarction occurred in case 2, in which the patient had shown severe symptomatic vasospasm on admission. In advanced cases, such as in case 2, the outcome is poor. The aneurysm may not be able to be approached before PTA because of severe vasospasm. In such cases, PTA must be performed carefully to avoid aneurysmal rerupture. Intraarterial papaverine infusion is safer than PTA for severe spasm in distal vessels. However the efficacy of papaverine is known to be transient in many cases. It is often difficult to determine the exact relationship between branches and the aneurysm in the presence of vasospasm. In such cases, we recommend that the rupture point be packed and that the aneurysmal neck remain unpacked. After vasospasm is cured and good general condition has been recovered, direct surgery can be performed. In summary, endovascular surgery is an effective option for treatment of ruptured aneurysm with symptomatic vasospasm.

Aged↗
PubMed1999

Symptomatic multifocal osteonecrosis. A multicenter study. Collaborative Osteonecrosis Group.

Osteonecrosis of the femoral head frequently occurs in a young population (mean age, approximately 35 years) and may lead to disabling arthritis requiring hip arthroplasty surgery. This disease is compounded when it has concurrent involvement of other joints. Multifocal osteonecrosis is defined as disease involving three or more anatomic sites. The purpose of this study was to review the demographic, clinical, radiographic staging patterns, and treatment options in patients with multifocal osteonecrosis to facilitate earlier diagnosis and optimize treatment. Twenty-one centers participated by submitting completed data forms on patients under their care after review of their databases. One hundred one patients were identified. Patient demographics, associated diseases, corticosteroids and other medications used, presenting joints, and symptomatology were evaluated. Radiographs and magnetic resonance imaging scans or both were used to diagnose and stage osteonecrotic lesions. Ninety-two of the 101 (91%) patients had a history of corticosteroid therapy. Twelve patients (of 14 tested) were found to have a coagulation disorder. All 101 patients had femoral head involvement. Osteonecrosis also was seen in the knee (96%), shoulder (80%), ankle (44%), and seven other sites. Overall, 631 joints were involved (6.2 lesions per patient). Bilaterality was common: hips, 98%; knees, 86%; and shoulders, 83%. Most lesions (69%) were in a precollapse stage at the time the patients presented for treatment. In eleven patients, the knee was the sole presenting symptomatic joint, and the shoulder and ankle were the sole presenting symptomatic joints in five and four patients, respectively. An improved understanding of the epidemiology, pathogenesis, and etiology of multifocal osteonecrosis will facilitate the diagnosis and treatment of this disease. In patients with osteonecrosis of the hip, all symptomatic joints should be evaluated with radiographs. In patients with osteonecrosis presumably not involving the femoral head, the patient's femoral heads should be evaluated radiographically, regardless of whether the hips are symptomatic.

Adolescent↗
PubMedDate not supplied

[Diagnosis and treatment of symptomatic and asymptomatic carotid disease].

OBJECTIVE: Provide a management strategy for the evaluation and treatment of extracranial internal carotid artery disease. BACKGROUND: Despite 50 years that have elapsed since the first carotid artery endarterectomy, surgical indications in symptomatic and asymptomatic carotid artery disease remain controversial. DESIGN: The most important studies on the treatment of symptomatic and asymptomatic internal carotid artery disease were reviewed. Special scenarios were analyzed including: intraluminal thrombus, carotid artery occlusion, dissection, ulceration, fibromuscular dysplasia, re-stenosis post endarterectomy and carotid artery disease coexisting with coronary artery disease. The current status of carotid angioplasty was discussed briefly. CONCLUSIONS: A patient-individualized approach based on the aforementioned studies and personal experience is provided. Endarterectomy is recommended in greater than 70% ICA symptomatic stenosis, in certain patients with 50 to 69% symptomatic stenosis, and exceptionally in asymptomatic patients, patients with associated coronary artery disease, ulceration, intraluminal thrombus and other less frequent scenarios.

Algorithms↗
PubMedDate not supplied

[Acute symptomatic epilepsies].

OBJECTIVES: To review the differentiating characteristics of symptomatic acute epilepsies, epidemiology, aetiology and controversies over treatment, and describe our experience with symptomatic acute epilepsy in cerebrovascular disorders. DEVELOPMENT AND CONCLUSIONS: The so-called symptomatic acute epilepsies show clearly differentiated characteristics with regard to true epileptic disorders: 1. A clearly identified causal association; 2. Generally tend not to recur; 3. Usually long-term anti-epileptic treatment is not necessary. Therefore the most suitable term for them is symptomatic acute seizures. They make up a large proportion of all newly-diagnosed epilepsies around 40%. The highest incidence occurs during the first year of life (probably because of the high incidence of seizures due to encephalopathies, metabolic disorders and infections) and in elderly patients (especially in relations to cerebrovascular disorders). The commonest causes are: cerebrovascular disorders, head injury, infections of the central nervous system, alcohol and drugs. The risk of subsequent epilepsy is increased in a subgroup of these patients, especially in cases with associated cerebrovascular disorders, head injuries and central nervous system infection. Long-term preventive treatment is rarely indicated in these patients.

Acute Disease↗
PubMed2001

Percutaneous intervention for symptomatic vertebral artery stenosis using coronary stents.

BACKGROUND: There is very limited experience with percutaneous treatment of symptomatic vertebral artery disease. Angioplasty and stenting for vertebral artery stenosis are still evolving and have generally been performed for asymptomatic disease. We performed vertebral artery stenting in 12 patients with vertebrobasilar transient ischemic attacks and present our short- and intermediate-term results. METHODS: A total of 12 lesions affecting the vertebral artery were treated by coronary stent placement. The mean age was 72 +/- 8 years and 83% were males (10 males, 2 females). Baseline characteristics included hypertension (11/12); hypercholesterolemia (8/12); coronary artery disease (8/12); and diabetes (5/12). Mean lesion length was 8.6 +/- 2.7 mm, mean calipered stenosis was 78 +/- 8%, and mean arterial diameter was 4.1 +/- 0.3 mm. All patients were symptomatic, fulfilling our criteria for vertebral artery angioplasty. All patients were followed for at least 6 months after treatment. RESULTS: All 12 lesions were successfully stented, with a mean residual stenosis of 11 +/- 6%. Clinical follow-up showed resolution or improvement of symptoms in all patients. One patient had symptomatic restenosis seven months after the initial procedure requiring repeat angioplasty. CONCLUSIONS: Stent placement for symptomatic stenosis involving the vertebral artery is safe and effective for alleviating symptoms of vertebrobasilar ischemia. Coronary stents appear to be well suited to treat atherosclerotic lesions of the vertebral artery.

Aged↗
PubMed2001

Prevalence of symptomatic BPE among Malaysian men aged 50 and above attending screening during prostate health awareness campaign.

OBJECTIVE: To study the prevalence of symptomatic BPE among Malaysian men age 50 and above attending prostate health awareness campaign and to identify differences in prevalence between different ethnic groups residing within metropolitan Kuala Lumpur. MATERIALS AND METHODS: Demographic data and the completed International Prostate Symptom Score (IPSS), maximal uroflow rate (Qmax) and prostate size of volunteers, aged 50 and above, who attended the prostate health awareness campaign were analyzed. Subjects with known prostate diseases or prostate surgery, bladder disorders and neurological disorders were excluded. RESULTS: 2086 volunteers attended the campaign. 575 men fulfilled the inclusion criteria and their demographic data, IPSS; peak flow rate and prostate volume were analysed. Overall, 18.9% and 39.6% of the men were severely and moderately symptomatic, respectively. The prevalence of moderate to severe lower urinary tract symptoms (LUTS) in Malays, Chinese and Indians were 70%, 59% and 50% respectively (p = 0.004). The commonest bothersome symptoms were nocturia (56%), frequency (50.4%) and sense of incomplete voiding (43.5%). The mean peak flow rate of the subjects was 15.4 ml/s. 20.9% and 55.2% of the subjects had peak flow less than 10 ml/sec and 15 ml/sec respectively. The mean prostate size was 25.1 cc. There is no significant difference in term of maximal flow rate and prostate size among Malays, Chinese and Indians in Malaysia. A good correlation was found between the total symptom score and the single disease-specific quality of life question (r = 0.69, p < 0.001). The correlation between IPSS and peak flow rate (r = -0.22, p < 0.001) and prostate volume (r = 0.11, p = 0.009) was weak. There was no correlation between IPSS and age (r = 0.06, p = 0.17). The prevalence of symptomatic benign prostate enlargement (BPE) was 39.3%. The prevalence increased 8% per decade from 41.7% for men aged 50 to 59 to 65.4% for men aged 70 or more. There is no significant difference in prevalence of symptomatic BPE among the three ethnic groups. The Prevalence of BPO was 15.8%. CONCLUSION: The correlation between symptom score, maximal flow rate and prostate size was poor and one cannot predict the value of one parameter by knowing one or more of the other parameters. There is a high prevalence of LUTS suggestive of benign prostatic obstruction in the apparently healthy Malaysian aged 50 and above attending the prostate health awareness campaign.

Age Factors↗
PubMed2002

DWI prediction of symptomatic hemorrhagic transformation in acute MCA infarct.

PURPOSE: Symptomatic hemorrhagic transformation is a severe complication of acute ischemic stroke which occurs at a higher frequency after thrombolysis. The present study was designed to analyze whether early DWI can be used for predicting the risk of hemorrhagic transformation with clinical worsening in MCA stroke patients. MATERIALS AND METHODS: Of 28 patients with a middle cerebral artery (MCA) infarct and proven MCA or carotid T occlusion on DWI and MR angiography performed within 14 hours after onset (mean 6.5 +/- 3.5 hours, median 5.2 hours), 4 developed hemorrhagic transformation with clinical worsening, while 24 did not. For the 2 groups, we compared admission NIHSS score, site of arterial occlusion, volume of DWI abnormalities, and several apparent diffusion coefficient (ADC) measurements: ADC(infarct) (mean ADC value of the whole infarct), ADC(core) (peak ADC decrease as calculated in a 57 mm(2) circular ROI, manually centered on the ischemic area with the lowest ADC value on the ADC maps), ADC(superficial) and ADC(deep). Discriminant function analysis was used to determine the most accurate predictors of symptomatic hemorrhagic transformation. RESULTS: The best predictor was the ADC(core) (F=5.34, p=2.9%, cut-off value=300 x 10(-6) mm(2)/s). This monovariate model allowed to correctly classify all 4 patients (ADC(core) 300 x 10(-6) mm(2)/s) with subsequent symptomatic hemorrhage, and 17 of the 24 patients without symptomatic hemmorrhage (ADC(core)>300 x 10(-6) mm(2)/s) (100% sensitivity, 71% specificity). CONCLUSION: Although preliminary, these results suggest that a simple measurement of minimum ADC values within an acute MCA stroke could be useful in targeting those patients with a high risk of severe hemorrhagic transformation.

Acute Disease↗
PubMed2002

Urodynamic effects of terazosin treatment for Japanese patients with symptomatic benign prostatic hyperplasia.

PURPOSE: For treating benign prostatic hyperplasia (BPH) 5 or 10 mg. terazosin hydrochloride daily has been routinely used in North America and Europe. We investigated the urodynamic effects of 2 mg. terazosin daily on Japanese patients with symptomatic BPH using pressure flow study. MATERIALS AND METHODS: A total of 20 Japanese patients 50 years old or older with symptomatic BPH underwent symptomatic and urodynamic evaluations, including pressure flow study, before and after terazosin treatment. Patients were given 1 mg. terazosin once daily for the first 7 days and they continued to receive 1 mg. terazosin twice daily for the following 3 weeks. RESULTS: At 4 weeks after terazosin treatment the International Prostate Symptom Score, quality of life index and maximum and average flow rates were significantly improved. Pressure flow study demonstrated decreased detrusor pressure at maximum flow, and minimum detrusor pressure during voiding and urethral resistance factor after terazosin treatment. Of the 20 patients 13 (65%) showed improvement in the linear passive urethral resistance relation. There was no significant difference in the maximum W. factor before and after terazosin treatment. CONCLUSIONS: Terazosin treatment, even 2 mg. daily, urodynamically relieved bladder outlet obstruction in Japanese patients with symptomatic BPH without any changes in detrusor contractility.

Adrenergic alpha-Antagonists↗
PubMed2002

Subclavian carotid transposition for symptomatic subclavian artery stenosis or occlusion. A comparison with the endovascular procedure.

BACKGROUND: Although subclavian-carotid transposition (SCT), among all extrathoracic revascularization procedures, has emerged as the treatment of choice for symptomatic subclavian artery (SA) stenosis or occlusion, some authors advocate percutaneous transluminal angioplasty with stenting as the optimum primary therapy. AIM: to assess safety, efficacy and durability of SCT in the treatment of symptomatic SA stenosis or occlusion. METHODS DESIGN: review of a prospectively maintained vascular surgical registry. SETTING: University vascular surgical service. PATIENTS: 39 patients requiring surgery for symptomatic stenosis or occlusion of the proximal SA from September 1985 to August 1999. INTERVENTION: SCT. MEASURES: data were collected prospectively from hospital charts and office medical records to determine demographics, risk factors, presenting clinical manifestation, blood pressure differentials, location of the SA lesion and early postoperative outcome. Long-term follow-up was available in all patients. Patency of the revascularization was determined by physical examination and non-invasive laboratory studies. RESULTS: The perioperative mortality and morbidity rates were 2.5% (1 of 39) and 2.5% (1 of 39), respectively. Immediate relief of symptoms was achieved in 100% of cases. Mean follow-up was 6.8 years. Revascularization neither failed during the follow-up period, nor did patients have recurrent symptoms. The overall survival rates at 1, 3, 5 and 10 years were 100%, 100%, 86% and 68%. Overall late mortality rate was 18.4%: no death was stroke related. CONCLUSIONS: SCT is a very safe and effective surgical procedure for the treatment of symptomatic SA atherosclerotic disease, ensuring an excellent long-term patency.

Arterial Occlusive Diseases↗
PubMed2002

A reassessment of carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic patients.

OBJECTIVE: Total occlusion of the contralateral internal carotid artery has often been considered to be a predictor of poor outcome after carotid endarterectomy (CEA) of ipsilateral carotid stenosis. Data from both the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study have suggested this to be true. However, each of these trials had relatively few patients with contralateral occlusion in the surgical arms of the studies. Recently, advocates of carotid angioplasty and stenting have suggested that this technique may be preferable in patients with a contralateral occlusion because of the perceived poor outcome with surgery. The purpose of this study was to review a large series of CEAs performed in patients with contralateral occlusion to see whether results differed from patients with patent contralateral arteries and to determine whether the presence of preoperative symptoms was an important factor in outcome in these cases. PATIENTS AND METHODS: A review was conducted of a prospectively compiled database of all primary CEAs performed at our institution from 1985 to 1999. Surgery was performed on 2420 patients, of whom 338 (14.0%) had contralateral total occlusion. RESULTS: Patients with contralateral total occlusion were more likely to be symptomatic (65.7% versus 60.1%; P =.1), male (70.9% versus 58%; P <.001), and hypertensive (63.9% versus 58.4%; P =.07) with a positive smoking history (42.6% versus 31.4%; P <.001) than patients with patent contralateral carotid artery. No significant difference was seen in the rates of perioperative neurologic events between patients with contralateral occlusion (3.0%) and those without (2.1%; P =.34). Among the total of 913 asymptomatic patients, of whom 115 had contralateral occlusion, no difference was seen in the rate of perioperative neurologic events (1.8% for contralateral occlusion cases; 1.9% for cases without contralateral occlusion). Among the total of 1507 symptomatic patients, of whom 223 had contralateral occlusion, no significant difference was seen in the rate of perioperative neurologic events (3.7% for contralateral occlusion cases; 2.2% for cases without contralateral occlusion; P =.2). CONCLUSION: The presence of contralateral occlusion does not appear to increase the perioperative risk of CEA. Although the risk of CEA in symptomatic patients with contralateral occlusion may be slightly increased, this must be weighed against the risk with medical treatment alone. CEA can be performed safely in patients with contralateral occlusion, which should not necessarily be considered a high-risk condition for surgery in favor of angioplasty and stenting.

Aged↗
PubMed2003

Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status.

BACKGROUND AND AIM OF THE STUDY: Symptomatic status in aortic stenosis is not always related to hemodynamic severity as estimated by the aortic valve effective orifice area (AVA), and other factors may be involved. It has been seen previously that, whilst ejection fraction is preserved, left ventricular (LV) longitudinal shortening may be selectively decreased in aortic stenosis, and hypothesized that this might be a marker of subendocardial ischemia as subendocardial myocardial fibers are oriented longitudinally. The present study examined the possible relationship between LV longitudinal shortening and symptoms in patients with aortic stenosis. METHODS: Relevant clinical and echocardiographic variables, including the percentage of LV longitudinal shortening, were measured in 131 consecutive patients with at least moderate aortic stenosis (AVA <1.5 cm2). RESULTS: Symptoms were found in 106 patients (exertional dyspnea 93%, resting dyspnea 25%, angina 57%, syncope 27%). Compared with asymptomatic patients, symptomatic patients had a smaller AVA (0.91 +/- 0.27 versus 1.13 +/- 0.20 cm2; p < 0.001), a lower LV longitudinal shortening (19 +/- 13 versus 28 +/- 9%; p = 0.01), and higher incidence of coronary artery disease (52 versus 20%, p < 0.008). Other variables significantly associated with symptoms included age, previous myocardial infarction, obesity, indexed AVA, LV mass index, LV ejection fraction, cardiac index, energy loss index, and valvular resistance. However, in multivariate analysis, the only variables independently associated with symptomatic status were patient age (p = 0.03), indexed AVA (p = 0.006), and LV longitudinal shortening (p = 0.04). The combination of indexed AVA with LV longitudinal shortening resulted in an improvement of the performance for the prediction of symptoms. CONCLUSION: These results show that LV longitudinal shortening is more closely associated with changes in symptomatic status than other currently used indices of LV systolic function. As such, it probably more closely reflects alterations in subendocardial myocardial function.

Age Factors↗
PubMed2003

The symptomatic patient with normal phorias at distance and near: what tests detect a binocular vision problem?

PURPOSE: Patients often manifest symptoms that appear to be related to binocular distress. Many of these patients have normal heterophoria at distance and near, making the etiology of such symptoms perplexing. We performed a visual examination of patients having normal heterophoria at distance and near in order to investigate which visual analysis tests differentiate symptomatic from asymptomatic patients. METHODS: Eighty subjects (30 symptomatic, 50 asymptomatic) with ages between 18 to 35 years of either sex and any race were pooled based on vision-symptom level determined by a 9-question standardized visual-symptoms questionnaire scored using a 100-point scale (asymptomatic: score > or = 85; symptomatic: score < or = 75). Inclusion/exclusion criteria included vision correctable to 6/6 (20/20) Snellen acuity or better in each eye, normal phorias, no latent cyclovertical heterophoria, and normal ocular health. RESULTS: Of the 30 symptomatic patients, 18 had reduced vergence facility response using 3 pd base-in/12 pd base-out loose prism at distance (n = 10; t-score = 2.41, p < 0.02, d = 76) and near (n = 15; t-score = 3.32, p < 0.01, df = 78) with a significant difference beyond the 0.02 level. No other test including measurement of accommodation, showed a significant between-group difference. However, three patients with normal vergence facility (distance and near) showed a reduced binocular accommodative facility response (+/-2.00 D at 40 cm). CONCLUSION: Given a patent with asthenopia, normal phorias, and visual acuity, a differential diagnosis may be made based primarily on using vergence facility and accommodative facility testing. From a clinical standpoint, the results expedite diagnosis of binocular vision abnormalities and direct treatment.

Accommodation, Ocular↗
PubMed2003

[A comparative study on severity of tuberculosis cases between those found by periodical chest X-ray examination and those found by symptomatic visit to OPD in Japan].

BACKGROUND: Japanese national tuberculosis control program (NTP) has included indiscriminate chest X-ray examination for adult population. METHODS: A comparative study on the severity of pulmonary tuberculosis cases in a hospital in Tokyo by the mode of detection (between cases found by periodical check and cases found by symptomatic visit) and previous history of X-ray examination (among cases detected by periodical check, cases detected by symptomatic visit but with previous history of periodical check and cases without history of chest X-ray examination during the past 3 years). RESULTS: The comparison between patients found by symptomatic visit with and without previous history of periodical check showed that there was no difference in the grade of sputum smear positivity at the time of diagnosis but that those without previous history of periodical check were more serious as to chest X-ray findings. The comparison between patients found by symptomatic visit with previous history of periodical check and those detected by the periodical check showed that the grade of smear positivity was less among those found by the periodical check but no difference as to chest X-ray findings, however, comparing cases of these two categories in the age group of 40-59, those detected by the periodical check were less serious as to both X-ray findings and smear result. There were 21 persons who were indicated requiring further investigation but actually were not examined. The severity of tuberculosis among these 21 persons were more serious as to the grade of smear positivity than those detected by periodical X-ray examination.

Adult↗