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At least 955 records · Page 53Linked to original sources
PubMed2000

Altered function of the hypothalamic stress axes in patients with moderately active systemic lupus erythematosus. II. Dissociation between androstenedione, cortisol, or dehydroepiandrosterone and interleukin 6 or tumor necrosis factor.

OBJECTIVE: To investigate adrenocorticotropin, androstenedione (ASD), cortisol, or dehydroepiandrosterone sulfate (DHEAS) before and during a corticotropin releasing hormone (hCRH) test in patients with moderately active systemic lupus erythematosus (SLE) undergoing low dose longterm glucocorticoid therapy, and to examine these hormones in relation to interleukin 6 (IL-6) or tumor necrosis factor (TNF). METHODS: Serum levels of hormones and cytokines were measured before and during an hCRH test. The results of 12 patients with SLE were compared to 12 healthy subjects (HS) and 12 healthy subjects given prior short term prednisolone (HS+P). RESULTS: Baseline and stimulated serum ASD, cortisol, and DHEAS were lower in patients with SLE vs. HS (p<0.005), but baseline and stimulated plasma adrenocorticotropin was normal in SLE. In SLE, but not in HS+P or HS, baseline and stimulated DHEAS was low in relation to cortisol or ASD (i.e., shift from DHEAS to cortisol or ASD). In patients with SLE, baseline and stimulated serum levels of adrenal hormones were lower in relation to IL-6 or TNF compared to HS or HS+P (p< 0.001). In contrast, in SLE patients, the baseline and stimulated pituitary hormone adrenocorticotropin was normal in relation to these cytokines. CONCLUSION: We found marked adrenal insufficiency and a shift in steroidogenesis to cortisol in patients with SLE, but a completely normal pituitary function (in absolute values and in relation to IL-6 or TNF). This may depend in part on prior longterm glucocorticoid therapy and changes of steroidogenesis due to cytokines. The situation in patients with SLE was not mimicked by high dose short term prednisolone in healthy subjects. Further longitudinal studies in untreated patients are needed to investigate the endocrine-immune interplay and its consequences during the course of SLE.

Adrenocorticotropic Hormone↗
PubMed2001

[Atrial septal defect in adults--opinions, procedures and controversies].

Atrial septal defect (ASD) accounts for 30-40% of congenital heart disease in adults diagnosed after the age of 40 and is after bicuspid aortic valve and mitral-valve prolaps the most common congenital cardiac malformation in adults. We have discussed current views on the pathological role of ASD in adults and controversies regarding its treatment. It is expected that increasing understanding of ASD pathophysiology, improved diagnostic methods and the possibility of transcatheter closure of interatrial defects will improve the treatment of patients with ASD.

Adult↗
PubMedDate not supplied

[Repair of interatrial septal defect with an Amplatzer device. Experience with 3 cases].

We performed transcatheter closure of an atrial septal defect (ASD) using an Amplatzer device in three patients, 2 women and 1 male child, aged 12, 54, and 4 years, respectively, coursing with ostium secundum ASD. Two with left to right shunt and the third with bidirectional shunt. The transesophageal echocardiogram revealed ASD with diameters of 13, 15, and 10 mm, the diameter with expanded catheter balloon was of 30, 26, and 17 mm, respectively. The superior border of the atrial septum was bigger than 5 mm in all three patients, whereas the inferior border could not be found through echocardiography in the patients aged 12 and 4 years. Amplatzer devices of 30, 26, and 17 mm were implanted, the inferior border of the first two could be supported on the aortic wall and the superior border on the septum. We observed a 100% occlusion in these two cases through ecocolor-Doppler. In the third patient, an inferior border of 16 mm and a superior border of 8 mm were determined, achieving and immediate and fast installation of the device with 100% occlusion. All three patients were in stable conditions, asymptomatic and without shunt at their one-month follow-up as revealed by a trans-thoracic echocardiography. It is concluded that the Amplatzer device is technically easy to install and yields adequate results even in patients with ample ASD and without inferior border of the inter-atrial septum.

Child↗
PubMed2002

[A case of racemose hemangioma of a bronchial artery complicated with atrial septal defect and localized peripheral ground-glass opacity].

We report a case of racemose hemangioma of the right bronchial artery complicated with an atrial septal defect (ASD) and ground-glass opacity localized in the right upper lung lobe. A 42-year-old woman was admitted for the pre-operative assessment of ASD. Aortography and selective angiography revealed that the right bronchial artery was markedly dilated and convoluted, draining into the right intercostal arteries and the right upper pulmonary vein. The patient was suffering from exertional dyspnea, but produced no bloody sputum. Since videobronchoscopy showed normal mucosal findings without bronchiectasis, primary racemose hemangioma of the right bronchial artery was diagnosed, and was treated by ligation of the bronchial artery and patch-closure of the ASD. The ground-glass opacity observed preoperatively in the periphery of the right upper lung lobe vanished after surgery. This opacity was considered to have been localized pulmonary congestion due to augmented hydrostatic pressure in the right upper pulmonary vein, induced by increased pulmonary blood flow through the ASD and the drainage route of the racemose bronchial artery into right upper pulmonary vein.

Adult↗
PubMed2002

Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects.

BACKGROUND: Transcatheter implantation of the Amplatzer septal occluder (ASO) is an alternative to conventional surgical closure of isolated secundum atrial septal defects (ASDs). Neither the clinical outcomes nor the costs of these procedures have been extensively compared. MATERIAL/METHODS: We performed a retrospective cohort study to evaluate cost-effectiveness in patients with secundum ASDs who underwent closure using either placement of an ASO or surgery. We utilized available TSI accounting data to estimate hospital costs. RESULTS: On the basis of trans-thoracic echocardiography, the procedures resulted in successful closure of the ASDs in 95.8% of patients in whom the ASO was implanted and 96.8% of surgical patients. Although there were no deaths in either group, complications occurred in 10.4% of patients in whom the ASO was implanted and 31.2% of surgical patients. The mean estimated cost per case treated with the ASO was $11,541 as compared with $21,780 for surgery. The average length of hospital stay per case treated with the ASO was 1.0 day as compared with 4.3 days for surgery. Sensitivity analyses based on our data identified no plausible situations in which the costs of surgery and of implantation of the ASO would be equal. CONCLUSIONS: The equally effective and less costly Amplatzer Septal Occluder appears superior to surgical closure of isolated secundum ASDs in qualifying patients. The transcatheter method is also associated with significantly lower morbidity. Consequently, our results support the use of the ASO as an alternative to surgery for the management of this common congenital lesion.

Adolescent↗
PubMed2000

[Cloning and expression of Shiga-like toxin type II variant B gene of E. coli].

A structure sequence and a DNA fragment including the signal peptide sequence and structure sequence of Shiga-like toxin II variant B subunit gene were amplified from E. coli strain O138 by PCR. After digested with restriction endonuclease EcoRI and BamHI, the two genes were orientally inserted into the polycloning site of expression vector pYA3334 (asd+) respectively. Recombinant plasmids pB0 and pB1 were constructed and amplified in E. coli X6212 (asd-). pB0 and pB1 were then introduced into avirulent Salmonella typhimurium vaccine strain X4550 (asd-) by serial transformation through intermediate strain X3730 (asd-) to construct recombinant SLT-IIvB strain. Results of nucleotide sequencing of the cloned fragments in pB0 and pB1 revealed that they were in correct ORF of SLT-IIvB. The results of SDS-PAGE and Western-blot showed that 7.6 kD protein of SLT-IIvB antigen was expressed at pretty high level in recombinant strain X4550(pB0). The results of mice immunization indicated X4550(pB0) could initiate the host to produce specific antibodies to SLT-IIvB and LPS-O antigen of X4550. So the recombinant strain X4550 (pB0) is worth considering as a candidate vaccine strain against porcine edema disease and Salmonella typhimurium infections.

Animals↗
PubMedDate not supplied

[Management of children with autism spectrum disorders].

INTRODUCTION: Autistic spectrum disorders (ASD) are characterized by qualitative deficits in communication, social skills and a restrictive repertoire of interests and behaviors. Recent studies suggest that they may represent one of the most prevalent neurodevelopmental disorders. METHOD: Treatment of core deficits of ASD are primarily speech and language, behavioral and educational interventions. Clinical management of ASD requires a multidisciplinary approach to identify behaviors that could interfere with the individual s ability to benefit from those interventions. Medications, such as neuroleptics, antiepileptic drugs, SSRI s, neurostimulants and others have been used to target specific behaviors. CONCLUSIONS: Further research is much needed if medications are eventually to have a greater role in the treatment of core ASD symptoms. Recent attempts at neurosurgical interventions cannot be justified by our present level of knowledge

Anticonvulsants↗
PubMedDate not supplied

Vein of Galen malformation combined with atrial septal defect in a neonate.

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein, whereby the interconnecting capillary network is missing. Such a malformation frequently occurs in the deep midline regions of the brain, and the subsequent increased flow into the draining vein of Galen substantially dilates in an aneurysmal manner. Congenital forms of the aneurysmal dilatation of the vein of Galen (AVG) often lead to death in the neonatal period, predominantly due to cardiac failure caused by the increased venous inflow as a consequence of the intracerebral arteriovenous shunting. In the presented case a male baby suffered from a rare combination of a cerebral AVF and an atrial septal defect (ASD). He was born at week 38 of pregnancy and subsequently developed tachydyspnoe. Ultrasound (US) and CT scans revealed a large bilateral AVF with dilated basal venous sinuses, hydrocephalus and brain atrophy. In the heart, severe right ventricular hypertrophy, patent ductus arteriosus and an ASD were detectable by US. Neurosurgical consultation rejected the possibility of an operative treatment due to size and localization of the lesion and the existing irreversible brain damage. The child died because of cardiac failure 6 days after birth. Autopsy examination in the brain demonstrated a large conglomerate of dilated blood vessels predominantly in the midline and left occipital lobe, edema and hydrocephalus. In the heart, the ASD detected by US proved to be an ostium secundum-type lesion. Histologically, the conglomerate of vessels revealed features of an AVF and matched the characteristics of AVG. Consequences of chronic ischemic brain injury were also present, with ferruginated neurons suggesting intrauterine damage caused by a congenital AVF. Based on data in the literature, we assume that the left-to-right shunt due to increased venous influx into the heart caused not only cardiomegaly, but may have also interfered with the normal development of the atrial septum leading to an ASD, contributing to the rapid progression of the cardiac failure.

Abnormalities, Multiple↗
PubMedDate not supplied

Surgical treatment for isolated hypoplasia of the right ventricle.

Four patients with isolated hypoplasia of the right ventricle who underwent intracardiac repair are described. An atrial septal defect (ASD) was successfully closed in 3 patients with mild hypoplasia of the right ventricle. The remaining patients underwent ASD closure and right atrium-to-pulmonary artery connection with a conduit with a bovine pericardial valve because of severe hypoplasia of the right ventricle and tricuspid valve. Postoperative angiocardiogram in the last patient demonstrated two-channel pathways from the right atrium to the pulmonary artery via both the right ventricle and external conduit. At long-term follow-up studies, 3 patients had developed arrhythmias and/or sinus node dysfunction, and one had died, probably because of arrhythmia, 13 years postoperatively. The right ventricular ejection fractions were below normal levels at 11 and 12 years postoperatively in 2 patients who underwent closure of ASD. It was concluded that the mild form of hypoplasia of the right ventricle should be surgically corrected by ASD closure, while right atrium-to-pulmonary artery connection or Fontan's operation should be chosen for cases of severe hypoplasia. Arrhythmias and hypofunction of the right ventricle are long-term problems after intracardiac repair of this anomaly.

Adolescent↗
PubMed2005

Thrombus formation on an atrial septal defect closure device.

Atrial septal defects (ASDs) are the most prevalent form of congenital heart disease presenting after childhood. Percutaneous closure has become a safe and effective strategy for managing adults with secundum-type ASDs. Reports on complications are rare. The present report discusses a case of rapid formation of a large thrombus on an ASD transcatheter closure device. The case highlights the importance of transesophageal echocardiography during the procedure and supports the role of periprocedural anticoagulation in transcatheter ASD closures.

Aged↗
PubMedDate not supplied

[Percutaneous closure of atrial septal defects using the Amplatzer device].

Percutaneous closure of an atrial septal defect (ASD) was undertaken in 10 patients aged from 3 to 33 years. The Amplatzer device was introduced intravenously and positioned under fluoroscopic and echographic control. The size of the ASD varied from 13 to 20 mm and that of the devices from 15 to 32 mm. One patient was operated for the removal of an improperly positioned device and closure of the ASD. All the other patients were discharged 24 hours after the procedure with successfull closure of the ASD. Complications were benign: spontaneously regressive arrhythmias (1 case) and migraines (2 cases). Our series reflects the experience of others, showing the faisability and efficiency of the procedure. Tridimensionnal or intracardiac echocardiography may improve this technique in the future.

Adolescent↗
PubMed2005

[Percutaneous treatment of atrial septal aneurysm].

Among a total number of 203 patients with atrial septal defects (ASD) or patent foramen ovale (PFO) who were treated by percutaneous closure, we selected 29 (19 with ASD and 10 with PFO) who fulfilled the criteria for atrial septal aneurysm. Eight patients had functional class II or III dyspnea, and 12 had a history of previous cerebrovascular accident (38%). Seven of the patients with ASD, had a single defect and 12 had multiple defects; 14 received a single occluder and 5 patients needed 2 or 3 devices. Follow-up transthoracic ultrasound study at 6 months showed the defect to be successfully closed in all 29 patients. After a mean follow-up time of 31 +/- 19 months, all patients were alive and symptom-free. Patients with atrial septal aneurysm and associated ASD or PFO can be successfully treated with Amplatzer septal occluders.

Adolescent↗
PubMed2005

[Heart condition before and after surgical treatment of atrial septal defect type II in adults].

UNLABELLED: ASD t. II is one of the common congenital heart abnormalities in adults. Early surgical or percutaneous correction in childhood is recommended, but in adults indications to surgical treatment are still controversial. With age physical functional class (NYHA) deteriorating is observed. In the natural course of the defect some patients could be asymptomatic up to third or fourth decade of life and in the middle aged we can observe clinical symptoms. PURPOSE: The aim of the study was to assess a condition of the heart and analyse some dependences between a value of PASP and degree of NYHA class and other echocardiographic parameters in patients before and after surgical repair of ASD t.ll. MATERIAL AND METHODS: 93 patients were involved in research (24.7% male, mean age 43.8+/-11 years ) with history of isolated ASD t.II. All patients were observed in follow-up (mean range--6.6+/-3.1 years). In all pts. before and after surgery the history of the specific symptoms of dyspnea on exertion, level of fatigue, physical examination with assessment a degree of heart failure (NYHA class), a value of PASP (mmHg), the pulmonary to systemic ratio (Qp/Qs) were performed. The patients were divided into two groups according to their age at the time of surgical correction: I group < 40 years and II group > 40 years. In statistic analysis Chp test, Fisher test, t-Student test and logistic regression model were performed. RESULTS: In our study we observe a significant improvement of NYHA class in both groups. A marked recovery from class III or IV to class I or II after operation was documented in 24 pts. (47%) in I group (p<0.00001) and 14 pts. (33%) in group II. (p<0.0001). The pulmonary artery pressure decreased significantly after surgery in both groups (33.1+/-7.7 vs 21.9+/-5.1 mmHg; (p<0.0001--I group) and 41.3+/-11.5 vs 23.4+/-6.2 mmHg; (p<0.0001--II group). We did not observe any significant correlations between NYHA class and PASP and also between PASP and Qp/Qs ratio before surgery in studied groups. (p>0.05). CONCLUSIONS: 1. Surgical repair of ASD t.II is an useful treatment in adult pts. because it improves hemodynamic status and normalise PASP independently of age at the time of repair. 2. More intensive symptoms of dyspnea or fatigue assessed by NYHA class do not correspondence with value of PASP in any age before repair. 3. With advanced age a higher degree of NYHA class correlates with increased value of Qp/Qs ratio. 4. Age over 40 years is not a contraindication to surgical treatment.

Adult↗
PubMedDate not supplied

[Best practice guidelines for the diagnosis of autistic spectrum disorders].

INTRODUCTION: The autism spectrum disorder (ASD) diagnostic process requires expertise both in the knowledge of autism as in teamwork strategies with different professionals, often working in different clinic services, and with parents. AIM: To recommend a consensus diagnostic procedure for ASD, that has been designed by the Study Group of the Instituto de Salud Carlos III. DEVELOPMENT: The reports emphasize the need to obtain a complete clinical history, covering personal, family and psychosocial antecedents; detailing the basic areas affected in ASD--social interaction, communication and restricted patterns of behaviour, activities and interests. Diagnostic tests to be used as a routine in all cases are described and analysed--including both psychoeducational and biomedical tests. Also, tests indicated in cases with suspected identifiable physical disorders are covered, as well as those medical tests to be used for research purposes only. CONCLUSION: The diagnostic procedure requires the implementation of a coordinated interdisciplinary assessment strategy, that needs to ensure the participation of professionals from very different fields in active collaboration with the family. Their role culminates in the preparation and delivery of a personalized report. Every diagnostic procedure needs to be accompanied by an action plan that includes immediate support to the person with ASD, as well as information to the family on resources and community initiatives in their living area.

Humans↗
PubMed2005

Use of a new 8 French intracardiac echocardiographic catheter to guide device closure of atrial septal defects and patent foramen ovale in small children and adults: initial clinical experience.

Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closure of atrial septal defect (ASD) and patent foramen ovale (PFO). The use of ICE to guide device closure of ASDs in small children (< 20 kg) has been very limited. We report on the use of a new, 8 Fr ICE catheter that possesses full color Doppler capabilities to guide device closure of ASDs in small children as well as to guide device closure of ASDs and PFOs in adult patients.

Adult↗
PubMedDate not supplied

Intervention pilot for parents of children with autistic spectrum disorder.

Parents of children who receive the diagnosis of autistic spectrum disorder (ASD) experience a situational crisis related to receiving the diagnosis, which causes feelings of distress and urgency to access services for the affected child. This paper describes a randomized trial (n = 31) that was conducted at a regional diagnostic center of a large metropolitan children's hospital to (a) refine a nursing intervention designed for parents of children with ASD and (b) to identify methodological revisions for a larger study. A secondary purpose was to test the effects of a post-diagnosis nursing intervention on parents' reports of stress, impact of event (diagnosis), and use of services after a child is newly diagnosed with ASD. The intervention consisted of usual care plus 3 hours contact with a pediatric nurse practitioner (PNP) for counseling, instruction, and assistance with implementation of the recommended treatment plan. The control group received only the usual care post-diagnosis, which consisted of a 1-hour consultation session to receive the results of diagnostic tests and a written copy of the recommended treatment plan provided by a developmental pediatrician and/or PNP. Between group differences in measures of "impact of event" and "perceived stress" were not statistically significant. This was attributed to a small sample size. A larger study is feasible and recommended with an expanded nursing intervention and a significantly larger sample recruited from an additional recruitment site. Nurses working with this special population must recognize that parents have information and counseling needs that begin after they receive the diagnosis of ASD for their child and can address these needs with a standardized nursing intervention.

Adult↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defect using the Amplatzer Septal Occluder: initial results of a single medical center in Taiwan.

The Amplatzer Septal Occluder (ASO) is the first and only device to receive full approval for clinical use in patients with secundum atrial septal defect (ASD) from the United States Food and Drug Administration. This study reports the device's initial results in Taichung Veterans General Hospital, a tertiary medical center in central Taiwan. Between October 2001 and December 2004, 39 consecutive patients (31 females, 8 males) with secundum ASD underwent attempt at transcatheter closure using the ASO under general anesthesia and transesophageal echocardiographic guidance. Six patients were excluded due to deficient rims (2 patients), multiple ASDs (1 patient), too large a defect (1 patient), too small a defect (1 patient) and 1 patient with associated atrial flutter. A total of 33 patients (26 females, 7 males) underwent the device closure procedure. The median age was 10.6 years (range 3.1-57.5 years) and median weight was 42 kg (range 13.5-73 kg). The median Qp/Qs ratio was 2.12 (range 1.02-5.52). The median balloon stretched diameter of the defect by sizing plate was 16 mm (range 5-37 mm). A total of 33 devices (median size 17 mm, range 7-38 mm) were implanted in 33 patients. The median fluoroscopy time was 10.1 minutes (range 5.9-29 minutes) and the median procedure time was 55 minutes (range 30-105 minutes). Complications included asymptomatic device embolization to the right ventricle in 1 patient (surgical removal) and transient complete atrioventricular block in 1 patient. Follow-up echocardiography at 10 minutes, 24 hours, 1 month, 6 months, 1 year and 2 years after the procedure showed complete closure rates of 76% (25/33), 91% (30/33), 100% (32/32), 100% (22/22), 100% (22/22), and 100% (9/9), respectively. In conclusion, transcatheter closure of secundum ASD using the Amplatzer Septal Occluder is safe and effective, with a very low complication rate.

Adolescent↗
PubMed2005

Treatment planning for patients with autism spectrum disorders.

Patients with autism spectrum disorders (ASDs) can present with extremely heterogeneous issues, and, therefore, their treatment can be very challenging. Most patients with ASDs will benefit from contact with a multitude of disciplines. In this article, treatment planning is structured in terms of the patient's life stages. Early on, assessment of developmental milestones, metabolic conditions, and hearing; making the diagnosis of ASD; and providing genetic counseling are salient. As the child grows, speech and language therapy, early intensive intervention, special education, parent training, and neurologic assessment become important. With greater age, behavior therapy, pharmacotherapy, occupational therapy, and sexuality issues are often in ascendancy. As the patient approaches and proceeds through adulthood, transition training, housing options, and guardianship issues may be priorities. Advocacy is relevant throughout the life span. Professionals have an obligation to familiarize parents with interventions likely to be fruitful or unhelpful. There is growing evidence that early intensive behavior intervention, though expensive, may produce lifelong gains in functioning. A variety of experimental and/or unproven treatments are identified; mental health professionals can help families with members who have ASDs by guiding them toward effective treatments and away from therapies of unknown value but with potential risks and/or costs.

Age Factors↗