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At least 937 records · Page 52Linked to original sources
PubMed1999

Prognostic value of pharmacological stress echocardiography in patients with known or suspected coronary artery disease: a prospective, large-scale, multicenter, head-to-head comparison between dipyridamole and dobutamine test. Echo-Persantine International Cooperative (EPIC) and Echo-Dobutamine International Cooperative (EDIC) Study Groups.

OBJECTIVES: The study compared the prognostic value of dipyridamole and dobutamine stress echocardiography in patients with known or suspected coronary artery disease. BACKGROUND: Extensive information is available on the relative diagnostic accuracy of the two tests assessed in a head-to-head fashion, whereas comparative data on their prognostic yield are largely preliminary to date. METHODS: Dipyridamole (up to 0.84 mg/kg over 10 min) atropine (up to 1 mg over 4 min) (DIP) and dobutamine (up to 40 microg/kg/min)-atropine (1 mg over 4 min) (DOB) stress tests were performed in 460 patients with known or suspected coronary artery disease. Patients were followed up for 38+/-21 months. RESULTS: The DIP was negative in 253 and positive in 207 patients. The DOB was negative in 242 and positive in 218 patients. During the follow-up, there were 80 cardiac events. For all cardiac events, the negative and positive predictive value were 83% and 17% for DOB, 84% and 19% for DIP, respectively (p = NS). Considering only cardiac death, by univariate analysis Wall-Motion Score Index (WMSI) at DIP peak dose (chi-square 13.80, p<0.0002) was the strongest predictor, followed by WMSI DOB (chi2 = 8.02, p<0.004) and WMSI at rest (chi2 = 6.85, p<0.008). By stepwise analysis, WMSI at DIP peak dose was the most important predictor (RR [relative risk] 7.4, p<0.0001). CONCLUSIONS: In patients at low-to-moderate risk of cardiac events, pharmacological stress echocardiography with either dobutamine or dipyridamole allows effective and grossly comparable, risk stratification on the basis of the presence, severity and extension of the induced ischemia.

Aged↗
PubMed2000

Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling.

Cardiac remodeling is generally accepted as a determinant of the clinical course of heart failure (HF). Defined as genome expression resulting in molecular, cellular and interstitial changes and manifested clinically as changes in size, shape and function of the heart resulting from cardiac load or injury, cardiac remodeling is influenced by hemodynamic load, neurohormonal activation and other factors still under investigation. Although patients with major remodeling demonstrate progressive worsening of cardiac function, slowing or reversing remodeling has only recently become a goal of HF therapy. Mechanisms other than remodeling can also influence the course of heart disease, and disease progression may occur in other ways in the absence of cardiac remodeling. Left ventricular end-diastolic and end-systolic volume and ejection fraction data provide support for the beneficial effects of therapeutic agents such as angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking agents on the remodeling process. These agents also provide benefits in terms of morbidity and mortality. Although measurement of ejection fraction can reliably guide initiation of treatment in HF, opinions differ regarding the value of ejection fraction data in guiding ongoing therapy. The role of echocardiography or radionuclide imaging in the management and monitoring of HF is as yet unclear. To fully appreciate the potential benefits of HF therapies, clinicians should understand the relationship between remodeling and HF progression. Their patients may then, in turn, acquire an improved understanding of their disease and the treatments they are given.

Adrenergic beta-Antagonists↗
PubMed2000

The hydroxyapatite-ABG hip system: 5- to 7-year results from an international multicentre study. The International ABG Study Group.

A proximally hydroxyapatite (HA)-coated hip prosthesis designed for proximal stem bonding and stress transfer was studied in a consecutive series of 398 patients in an ongoing, prospective multicenter study. Follow-up was 5 to 7 years. The clinical results were excellent with a mean preoperative Merle d'Aubigné score of 8.5 and 17.3 at 5 years. Only mild thigh pain not necessitating analgesics or a walking stick was reported in 3.6% at 5 years. Three cups and 3 stems had to be revised, all before the 2-year assessment and mainly for technical reasons. No components needed revision after 2 years. The 5-year HA-coated component survival was 99.2%. Serial radiographs showed excellent osseointegration, which was independent of pre-existing bone stock. The rate of radiographic bone remodeling was highest during the first 3 years, and positive bone remodeling (bone formation) preceded negative bone remodeling (bone resorption). The concept of transitional load transfer from proximal to distal could be acknowledged, with proximal load transfer highest in 77%. The combination of anatomic stem design with distal overreaming and proximal HA coating was thought to be the reason for these excellent results. Proximal circumferential osseointegration seems to be real because no linear or distal osteolysis was observed.

Adult↗
PubMed1998

Effectiveness of cataract surgery in Barcelona, Spain site results of an international study. Barcelona I-PORT investigators. International Patient Outcomes Research Team.

OBJECTIVES: To describe the impact of cataract surgery on visual function and health status in terms of clinical indicators as well as perceived health and functional capacity, and to identify patient characteristics and differences in clinical management that might affect outcomes. SUBJECTS AND METHODS: Observational longitudinal study of a cohort of 218 patients aged 50 or older undergoing first eye cataract surgery. Patients were evaluated pre- and postoperatively by clinical examinations (visual acuity [VA], ocular and medical comorbidity) and standardized telephone interviews. Main outcome measures included: the VF-14 Visual Function Index, the Cataract Symptom Score (CSS), the Sickness Impact Profile (SIP), and global measures of patients' trouble and satisfaction with vision. RESULTS: Significant improvement in all outcomes measures were observed at 4 months postoperatively (P < 0.001). However, the proportion of improved patients varied according to the outcome considered: VA (87%), CSS (72%), VF-14 (62%), and SIP (38%). Patient characteristics associated with higher a level of improvement were: worse preoperative visual function (VA, CSS, VF-14) (P < 0.001), less ocular comorbidity (P < 0.05), less postoperative complications (P < 0.05) and better preoperative general health status (SIP) (P < 0.01). The differences in clinical management were not associated with the outcomes (effectiveness) of surgery. CONCLUSIONS: A large proportion of patients benefit from cataract surgery, the greatest gain corresponding to visual function rather than to general health status. Since effectiveness of surgery is unrelated to operative procedures, less costly practices (i.e., day case surgery and loco-regional anesthesia) should be promoted.

Aged↗
PubMed1997

Diagnosis of Alzheimer's disease. Report of an International Psychogeriatric Association Special Meeting Work Group under the cosponsorship of Alzheimer's Disease International, the European Federation of Neurological Societies, the World Health Organization, and the World Psychiatric Association.

Current knowledge with respect to the diagnosis of Alzheimer's disease (AD) is reviewed. There is agreement that AD is a characteristic clinicopathologic entity that is amenable to diagnosis. The diagnosis of AD should no longer be considered one of exclusion. Rather, the diagnostic process is one of recognition of the characteristic features of AD and of conditions that can have an impact on presentation or mimic aspects of the clinicopathologic picture. The present availability of improved prognosis, management, and treatment strategies makes the proper, and state-of-the-art, diagnosis of AD a clinical imperative in all medical settings. Concurrently, information regarding the relevance and applicability of current diagnostic procedures in diverse cultural settings must continue to accrue.

Aged↗