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At least 793 records · Page 44Linked to original sources
PubMed1993

[Mirizzi syndrome--a contraindication for laparoscopic surgery].

The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct. The type I is better treated with a partial cholecystectomy, the type II with a partial cholecystectomy and a bilio-digestive anastomosis. Due to a severe inflammatory process with dense adhesions and odematous changes of the hepato-duodenal ligament, it is dangerous to prepare the Calot's triangle, in case of conventional cholecystectomy and/or in case of laparoscopic cholecystectomy. From 1986-1991 we have successfully treated 10 patients according to this concept (7 patients with type II, 3 patients with type I). We have no mortality and no lesion of the biliary system. One patient has been reoperated because of a postoperative hemorrhage and biliary fistula. One patient developed a benign stricture which could be dilated two months after the procedure. Two patients were found with an incidental carcinoma of the gallbladder.

Adult↗
PubMed1996

[Are beta-blockers generally contraindicated in patients with peripheral arterial occlusive disease?].

Ninety patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease were investigated to determine the effect of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial blood flow. Walking distance and the resistance index in the femoral artery were measured before and after 3 months medication and compared with the findings in controls (30 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease) who received placebo. Patients with peripheral arterial occlusive disease who were treated with atenolol 50 mg/day demonstrated significant decreases in both pain-free and maximal walking distance. In contrast, the walking distances in those given celiprolol 200 mg/day and those who received isosorbide dinitrate 80 mg/day did not differ from the distances in control subjects. The Doppler flow through the femoral artery, as measured by color duplex sonography, showed a significant decrease in resistance index, both in patients given celiprolol and in those given isosorbide dinitrate. In patients treated with atenolol the resistance index rose significantly. The results of this study confirm that the beta-adrenoceptor blocker celiprolol exerts a supplementary vasodilatory action resembling that of nitrates and hence can be used in patients with chronic ischemic heart disease and impaired peripheral arterial perfusion.

Adrenergic beta-Antagonists↗
PubMed1996

[Indications and contraindications for liver transplantation].

Liver transplantation (LT) is a therapeutic method in many, otherwise infaust diseases of the liver. During the recent decade the experimental therapeutic procedure has become a routine therapeutical method. The stage of clinical experiment was ultimated by the Washington Conference held on the consensus in LT indications (1983). Large centries (USA, England, Germany) yield 80-100 liver transplantations per year. The recent years have recorded a change in some principal opinions on LT. It is possible to state that liver transplantation is being abstained from cases with more extensive primary neoplamatic affliction of the liver. Conservative therapy in primary biliary cirrhosis of the liver by means of ursodeoxycholic acid has shifted the LT indication into the later stages of the disease. The opinions on the meaning of LT in alcoholic cirrhosis remain still unsettled. LT remains unambiquously indicated in life-endangering fulminant and subfulminant liver failures. Among the viral diseases, attention is paid to liver cirrhosis caused by infection by the hepatitis C virus. Cirrhosis due to hepatitis B has a better prognosis, owing to the complex antiviral therapy. Liver transplantation represents, beside the main indications, the therapy of first selection, e.g. also in Wilson's disease, alpha-1-antitrypsin deficiency, alveolar echinococcosis etc. (Tab. 1, Fig. 2, Ref. 54.)

Contraindications↗
PubMed1996

[Intermittent atrial fibrillation/flutter: contraindication for implantation of a dual chamber pacemaker?].

UNLABELLED: The programming of dualchamber pacemakers to DDD(R) mode is not recommended in patients with paroxysmal atrial fibrillation/flutter, because the pacemaker detects atrial fibrillation/flutter and paces the ventricle up to the pacemaker's upper tracking rate. Some newer pacemakers have the feature to switch automatically from DDD(R) to DDIR mode at the onset of atrial tachyarrhythmias. The aim of the study was to assess how many patients who received such a new DDDR pacemaker with automatic mode switch can be programmed to DDD(R) mode during follow-up. The dual-chamber pacemaker Thera DR (Medtronic) was implanted for clinical evaluation in 142 patients (65 +/- 16 years, male n = 86; female n = 56). Paroxysmal atrial fibrillation/flutter was present in 54 patients, with an additional 2nd or 3rd degree AV-block in 13 and no high-degree AV block in 22 cases; an AV node ablation was performed in 19 patients. Pacemakers were programmed to DDD(R) mode at discharge in 52 of 53, at month 1 in 44 of 46, and at month 3 in 28 of 30 cases. In respect to the programming to DDD(R) mode there were no statistically significant differences to patients without paroxysmal atrial fibrillation/flutter. CONCLUSION: Paroxysmal atrial fibrillation/flutter was present in 38% of the studied patients. During follow up more than 90% of the patients were paced in the DDD(R) mode.

Aged↗
PubMed1996

Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

This report provides updated information concerning the potential adverse events associated with vaccination for hepatitis B, poliomyelitis, measles, mumps, diphtheria, tetanus, and pertussis. This information incorporates findings from a series of recent literature reviews, conducted by an expert committee at the Institute of Medicine (IOM), of all evidence regarding the possible adverse consequences of vaccines administered to children. This report contains modifications to the previously published recommendations of the Advisory committee on Immunization Practices (ACIP) and is based on an ACIP review of the IOM findings and new research on vaccine safety. In addition, this report incorporates information contained in the "Recommendations of the Advisory Committee on Immunization Practices: Use of Vaccines and Immune Globulins in Persons with Altered Immunocompetence" (MMWR 1993;42[No. 44-4]) and the "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" (MMWR 1994;43[No. RR-1]). Major changes to the previous recommendations are highlighted within the text, and specific information concerning the following vaccines and the possible adverse events associated with their administration are included: hepatitis B vaccine and anaphylaxis, measles vaccine and a) thrombocytopenia and b) possible risk for death resulting from anaphylaxis or disseminated disease in immunocompromised persons; diphtheria and tetanus toxoids and pertussis vaccine (DTP) and chronic encephalopathy; and tetanus-toxoid-containing vaccines and a) Guillain-Barre syndrome, b) brachial neuritis, and c) possible risk for death resulting from anaphylaxis. These modifications will be incorporated into more comprehensive ACIP recommendations for each vaccine when such statements are revised. Also included in this report are interim recommendations concerning the use of measles and mumps vaccines in a) persons who are infected with human immunodeficiency virus and b) persons who are allergic to eggs; ACIP is still evaluating these recommendations.

Bacterial Proteins↗
PubMed1996

Is severe left ventricular dysfunction a contraindication to participation in an exercise rehabilitation programme?

OBJECTIVE: To evaluate the effects of an exercise training programme on patients with chronic left ventricular dysfunction. DESIGN: Intervention, before and after the trial. SETTING: Johannesburg Cardiac Rehabilitation Centre, a phase III community-based cardiac rehabilitation facility. PATIENTS: A consecutive sample of 28 patients who were recovering from acute myocardial infarction and who had a left ventricular ejection fraction of 30% or less. Twenty two patients completed the exercise training programme. INTERVENTION: A medically supervised exercise training programme of 6 months' duration. Type of exercise: walking, jogging or cycling. Intensity: 65-85% of the patient's maximal heart rate achieved during treadmill testing. DURATION: 30-45 minutes. Frequency: 3 times a week. Patients who attended fewer than 60% of all prescribed sessions were considered drop-outs. MAIN OUTCOME MEASURES: Haemodynamic, left ventricular function and effort tolerance parameters before and after training. RESULTS: Patients who completed the exercise training programme showed a significant improvement in maximal exercise capacity and a significant reduction in their cardiovascular demands during submaximal exercise. Peak oxygen consumption was increased by 12% after training (19.4 +/- 3 v. 21.8 +/- 4.8 ml/kg/min; P < 0.05) and exercise time to exhaustion by 33% (527 +/- 171 v. 700 +/- 186 seconds; P < 0.001). The double product at the same submaximal workload was significantly reduced (214 +/- 52 v. 194 +/- 44 beats/min x mmHg x 10(2); P < 0.05). These benefits were achieved without any adverse effects on resting (25.4 +/- 5 v. 28.5 +/- 7.9%; P < 0.05) or exercise (27.3 +/- 7.7 v. 29.9 +/- 9.5%; P > 0.05) left ventricular ejection fraction. CONCLUSIONS: Our results show that patients with chronic left ventricular dysfunction can benefit from an exercise training programme and that those benefits can be achieved without risk of further deterioration in left ventricular function. Physical training constitutes another therapeutic option which could be added to the comprehensive management of these patients.

Adult↗