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Results for “Life Table Method”

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At least 415 records · Page 23Linked to original sources

PubMed1993

Benefit of carotid endarterectomy after prior stroke.

PURPOSE: The benefit of carotid endarterectomy (CEA) in preventing recurrent stroke in patients who have sustained a previous stroke remains controversial. The purpose of this study was to evaluate the immediate results and long-term benefit of CEA after recovery from a prior ipsilateral stroke. METHODS: Between 1980 and 1990, 85 patients underwent CEA for prior stroke with an average follow up of 54 months (range 0.3 to 130). The interval from prior stroke to CEA averaged 19.8 months (range 0.1 to 158.3). Vascular risk factors included hypertension in 70.6%, diabetes in 20.0%, history of smoking in 80.0%, and associated coronary artery disease in 51.8% of the patients. RESULTS: There were no perioperative deaths. Four patients (4.7%) had an ipsilateral stroke within 30 days of operation. During the follow up 31 patients (36.5%) died. The leading cause of death was cardiac (54.8%) followed by cancer (16.1%). By life-table methods, the cumulative incidence of recurrent stroke at 9 years was 14% for strokes in the ipsilateral distribution, for an annual stroke risk of 1.6% per year. The cumulative incidence of stroke in other distributions was 5%, for an annual stroke risk of 2.1% per year for all strokes. When interval to operation, preoperative stroke severity, vascular risk factors, and neurologic symptoms were evaluated, no independent indicator of increased risk of recurrent postoperative stroke could be identified. CONCLUSION: These results demonstrate a marked improvement over the natural history and best medical therapy for these lesions as reoperated in the literature. We conclude that CEA is beneficial in preventing recurrent stroke in this group of patients and should be considered the appropriate management in this setting.

Adult↗

PubMed2003

Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades.

OBJECTIVE: The purpose of this study was to examine patterns of diagnosis and relative survival in women who had a diagnosis of primary invasive epithelial ovarian cancer (EOC) from 1973 to 1997, with follow-up through the end of 1999. STUDY DESIGN: From the population-based Surveillance, Epidemiology and End Results (SEER) Program, 32,845 women diagnosed between 1973 and 1997 were used for analysis. The study population was divided in three cohorts based on year of diagnosis and the cohorts were compared with respect to variables of interest by using chi(2) tests and relative survival analysis by the life table method. RESULTS: There was an increase in the proportions of minorities diagnosed with EOC, of women 60 years or older at diagnosis, and of women undergoing surgery over time. Survival continuously improved over time, although older patients (60 years or older) and African Americans continued to have the poorest survival. CONCLUSION: Over time, relative survival of women who had primary invasive EOC diagnosed improved.

Adolescent↗

PubMedDate not supplied

PTA and laser assisted PTA combined with simultaneous surgical revascularization.

In this study we investigated the efficacy of percutaneous transluminal angioplasty (PTA) and laser percutaneous transluminal angioplasty (LPTA) as an adjunct to surgery in patients with peripheral vascular disease. We report 84 cases of the simultaneous association of direct arterial surgery and angioradiological procedures to treat 82 patients with arterial occlusive disease of the lower limbs. Sixty-five patients (79.2%) were affected by severe claudication and 14 (19.6%) presented with rest pain or gangrene. One patient (1.2%) had signs of acute ischemia. PTA or LPTA were utilized as an inflow procedure in 41 cases (48.8%), as an outflow procedure in 24 (28.6%) and in 19 cases (22.6%) to recanalize an arterial occlusion in the contralateral limb opposite to surgical interventions. Immediate postoperative patency was achieved in 79 cases (94.0%), while in 5 cases (6.0%) it was impossible to perform a satisfactory balloon dilatation. The complication rate was 16.6%: 10 perioperative thromboses, 1 plaque dissection, 1 peripheral embolus, 1 haemorrhage and 1 femoral nerve lesion. No perioperative mortality occurred in this group of patients. Long term patency, analyzed with the life-table method (mean follow-up: 28 months) was respectively 78.0%, 76.3% and 78.9% at 5 years. These data indicate that the combined revascularization technique should always be recommended in properly selected patients because it is less invasive, the surgical risk and operative time are reduced and associated with early and long term cumulative patency rates comparable to those of extensive surgery.

Adult↗

PubMedDate not supplied

Leflunomide in rheumatoid arthritis in daily practice: treatment discontinuation rates in comparison with other DMARDs.

OBJECTIVE: To evaluate the treatment discontinuation rate of leflunomide in rheumatoid arthritis (RA) in comparison with the discontinuation of other disease modifying anti-rheumatic drugs (DMARDs), in daily practice, in a single center and during the same period of time. METHODS STUDY DESIGN: 3-year, retrospective, monocenter. PATIENTS: RA patients for whom leflunomide or another DMARD was initiated between 1998 and 2001 (several DMARDs could be initiated for a given patient during this period). Collected data: For each patient, demographic and disease data. For each treatment course, date of initiation, if relevant date of discontinuation and reason for discontinuation. ANALYSIS: Percentage of patients discontinuing treatment over time (life table method; Kaplan-Meier), comparison between leflunomide and the "any other DMARD" or methotrexate groups using the Log-Rank test. RESULTS: During the study period, 515 DMARDs were initiated in 285 patients. Leflunomide was initiated in 161 patients who were older and had a longer disease duration than the other treated patients (59 +/- 13 years and 14 +/- 9 years versus 54 +/- 15 years and 11 +/- 10 years in the leflunomide group and other DMARDs group respectively). Discontinuation rate of leflunomide after 1 year was 56.7%, mainly because of adverse drug reactions (41.6%). The discontinuation rate whatever the reason and for toxicity was higher for leflunomide than for other DMARDs studied. However discontinuation for inefficacy was similar in both groups. CONCLUSION: This study conducted in conditions of daily practice when leflunomide was first available suggests a higher discontinuation rate of leflunomide because of adverse events when compared to other DMARDs.

Adjuvants, Immunologic↗

PubMedDate not supplied

A prospective multicenter clinical trial of 3i machined-surface implants: results after 6 years of follow-up.

PURPOSE: In this prospective multicenter clinical study, 1,179 3i standard threaded and self-tapping implants were followed for up to 6 years and monitored according to established success criteria. MATERIALS AND METHODS: A total of 493 patients (240 men and 253 women) with a mean age of 45.1 years at implant surgery were enrolled at 6 research centers after being screened for exclusion criteria. Implants were placed according to a 2-stage surgical protocol with a minimum of 4 months of submerged healing in the mandible and 6 months in the maxilla. Restorations included 633 prostheses, the majority of which were fixed partial dentures in the posterior mandible or maxilla or single-tooth replacements in the anterior maxilla. RESULTS: One hundred four implants (8.8%) did not meet success criteria and were designated as failures, and 222 implants (18.8%) were lost to follow-up. The cumulative success rate according to life table methods was 91.1% at 6 years. DISCUSSION: Sixty percent of the failed implants were short (< or = 10 mm long), and their cumulative success rate as a group at 6 years was 89.0%, compared to 93.1% for longer implants (P < .05). Thirty-three percent of all failures were implants placed in the posterior maxilla, for a 5-year cumulative success rate of 87.4%. CONCLUSION: It appears that limited bone dimensions and poor-quality bone have an impact on the performance of these machined-surface implants.

Bone Density↗

PubMed2003

Epilepsy and multiple sclerosis in Sicily: a population-based study.

PURPOSE: To evaluate the association between epilepsy and multiple sclerosis (MS), we analyzed the incidence of epilepsy in a population-based incidence cohort of MS in Catania, Sicily. METHODS: According to Poser's diagnostic criteria, 170 incident cases of MS have been identified from 1975 to 1994 in the city of Catania. All these subjects underwent a complete neurological examination to confirm the diagnosis of MS and to identify those patients with a history of seizures. Diagnosis of epilepsy was based on the criteria proposed by the International League Against Epilepsy (ILAE) in 1993, and seizures were classified according to the classification of the ILAE, 1981. RESULTS: From 1975 to 1994, 170 subjects with MS had the clinical onset of the disease. The mean annual incidence of MS was 2.3/100,000 (95% CI, 2.0-2.6). Of the 170 defined MS patients, four developed epilepsy after the onset and also diagnosis of MS, giving an incidence rate of epilepsy of 285/100,000 person years at risk (95% CI, 119-684) and 147.8/100,000 when age adjusted to the world standard population. The cumulative risk of developing epilepsy after the onset of MS, evaluated by using the life-table methods, was zero at 1 year and 1.76% at 5 years. Of these four patients, three were classified as having partial seizures with secondary generalization and one with tonic-clonic seizures. CONCLUSIONS: Our data are consistent with those reported in literature suggesting that the risk of developing epilepsy is threefold higher among MS patients than in the general population.

Adolescent↗

PubMed1998

Bypass to the perigeniculate collateral vessels. A useful technique for limb salvage: preliminary report on 22 patients.

PURPOSE: We describe our initial experience with the use of perigeniculate vessels as outflow tracts in infrainguinal revascularizations for critical limb ischemia. METHODS: Twenty-two such reconstructions were carried out in 20 patients over a 2-year period. Indications for surgery consisted of tissue loss in 9 patients and rest pain in the other 13 patients. Inflow was obtained from the femoral vessels. A variety of graft materials were used, including saphenous vein (16 patients), polytetrafluoroethylene (2 patients), composite (1 patient), and arterial homografts (3 patients). The perigeniculate vessels used were the medial sural artery to the gastrocnemius (arteria suralis) in 16 patients and the highest genicular artery (arteria genu suprema) in the other 6 patients. These vessels were approached via a medial above-the-knee popliteal-type exposure. RESULTS: There were three postoperative deaths. Mean follow-up for the other 17 patients averaged 12 months (range, 3 to 37 months). Three grafts failed (thrombosis) during follow-up, leading to two above-the-knee amputations. One graft stenosis was treated with percutaneous angioplasty. The average postoperative increase in the ankle-brachial index was 0.20. CONCLUSION: These early results appear promising with a 1-year primary patency rate of 77%, assisted primary patency rate of 85%, and a limb-salvage rate of 90% according to the Kaplan-Meier life-table method. This technique is particularly useful when adequate length saphenous vein is not available, no other outflow vessels are available, or other outflow vessels are very calcified and not safely clamped. The continued study of the long-term effectiveness is warranted.

Aged↗

PubMed1992

Pattern of recurrence of illness after recovery from an episode of major depression: a prospective study.

OBJECTIVE: This study assessed prospectively the pattern of recurrence of illness after recovery from an episode of major depression. METHOD: Seventy-two patients who had recovered from an episode of primary, nonbipolar, nonpsychotic major depression were evaluated bimonthly with the Comprehensive Psychopathological Rating Scale for a period ranging from 20 to 108 months (median = 66 months). New ("prospective") episodes were ascertained with a structured diagnostic interview. The probabilities of remaining well after the index episode and after the first prospective episode were assessed by the life-table method. The severity and duration of prospective episodes and the index episode were compared by linear regression analysis. RESULTS: The probability of remaining well after recovery from the index episode was 76% at 6 months, 63% at 1 year, and 25% at 5 years. The risk of recurrence was lower among patients receiving prophylactic treatment with antidepressants and/or lithium and among those with histories of fewer than three previous episodes. The probability of remaining well was significantly lower 2 years after the first prospective episode than 2 years after the index episode. A pattern of increasing severity from the index episode to the first, second, and third prospective episodes was observed and was not affected by treatment. CONCLUSIONS: Major depression has a high rate of recurrence, even when bipolar and psychotic cases are excluded. The highest rate is observed during the first months after recovery from an episode. Prophylactic drug treatment reduces the risk of recurrence but apparently does not affect the trend toward increasing severity of subsequent episodes.

Adult↗

PubMed1997

Should balloon angioplasty and stents have any role in operative intervention for lower extremity ischemia?

Balloon angioplasty has been combined with open vascular surgery to treat lower extremity ischemia due to multilevel occlusive disease. The purposes of this study were: (1) to compare staged and simultaneous approaches to determine the optimal method for combining endovascular and open techniques and; (2) to assess the role of stents in intraoperative balloon angioplasty. Among 274 patients undergoing lower extremity revascularization over 30 months, 38 (13.9%) required a combination of endovascular and open techniques; 17 were staged (endovascular followed at an interval by distal open surgery) and 21 were simultaneous (intraoperative balloon angioplasty with or without stent placement at the time of open surgery). Groups were similar with respect to demographics, lesions treated with endovascular intervention, incidence and location of stent placement, and results of surgery. Additional operating time required for intraoperative endovascular intervention was 41.0 +/- 30.7 min., fluoroscopic time was 3.9 +/- 2.4 min. and contrast administered was 58.8 +/- 28.1 ml. There was no perioperative mortality. Length of stay was longer in the staged than in the simultaneous group (p < 0.01). Cumulative combined primary patency at 1 year by life-table methods was 82 +/- 10% in the staged group and 83 +/- 9% in the simultaneous group (p = 0.79). Mean follow-up was 13 +/- 6 months. There is a role for balloon angioplasty and stent placement in operative revascularization of ischemic limbs in selected patients: patency was similar to that produced with the staged approach while the length of stay was shorter. Intraoperative balloon angioplasty is safe and effective and stents permit a measure of control in assuring an optimal intraoperative postangioplasty result.

Aged↗

PubMed1995

Treatment of uveal melanoma metastatic to the liver: a review of the M. D. Anderson Cancer Center experience and prognostic factors.

BACKGROUND: Liver metastasis develops in approximately two-thirds of patients with recurrent uveal melanoma. Despite therapy, the median survival of those with liver metastasis is 5 to 7 months. The recognition of a grave prognosis associated with liver metastasis has led to evaluation of new modalities of therapy, including the use of regional therapies such as intrahepatic arterial chemotherapy and either embolization or chemoembolization of hepatic metastases. In this study, the results of an institutional experience over the past 2 decades are reviewed and prognostic factors that affect survival from the time the liver metastasis is diagnosed are assessed. METHODS: In this study of 201 patients with uveal melanoma involving the liver who were treated at M. D. Anderson Cancer Center between 1968 and 1991, the authors restrospectively reviewed the cases and compared the results of systemic therapies, hepatic intra-arterial chemotherapies, and chemoembolization of liver metastases. Cox's multivariate analysis and stepwise logistic regression were then computed to determine significant prognostic variables. RESULTS: The systemic therapies produced a response rate of less than 1%. Chemoembolization was the most effective treatment, inducing responses in 36% of patients. Survival curves were calculated using the life-table method of Kaplan and Meier. Patient- and tumor-related characteristics were examined and their relation to on survival from the time of diagnosis of liver metastasis was determined. Levels of serum alkaline phosphatase, total bilirubin, and lactic dehydrogenase plus response to treatment showed a strong relation to survival. In contrast, univariate analysis showed that patient age and gender, metastasis free interval, presence of extrahepatic metastasis, and type of therapy for liver metastasis did not influence survival. Multivariate stepwise regression analysis identified serum alkaline phosphatase and metastasis free interval as the main independent prognostic factors for survival after liver metastasis diagnosis. CONCLUSIONS: Of the three modalities of therapy used for choroidal melanoma metastatic to the liver, only chemoembolization using cisplatin-based regimens produced a meaningful response rate. Information from this analysis can be used to predict the outcome of patients with uveal melanoma metastatic to the liver. Patients with metastatic ocular melanoma confined to the liver should be treated with chemoembolization and should not be included in chemotherapy trials designed for cutaneous melanoma.

Adult↗

PubMed1993

Nursing implications of low-dose heparin to infusate to improve infusion site survival in children.

Initiation of intravenous (i.v.) infusions in hospital wards is a common surgical procedure. Unfortunately many of these infusions will fail due to phlebitis and/or extravasation. Such failure may cause considerable patient discomfort, interfere with i.v. therapy and increase the nurse's workload. I.v. problems with adults have been evaluated extensively, however little attention has been given to children. Heparin is effective in reducing thrombus formation and studies have demonstrated other properties as well, such as anti-inflammatory, anti-irritant, maintenance of endothelial integrity and homeostasis, and tissue healing. The purpose of this study was to determine if the addition of low-dose heparin to infusate would prolong infusion site survival in children. An experimental design was used whereby patients were randomly allocated into control and treatment groups. The treatment group received pre-mixed fluids containing 1 unit/ml of heparin whilst the control group received standard fluids. Data were collected using a standard form and information such as type and size of cannula, sex, age, date and time of cannulation, site, signs of phlebitis/extravasation, reasons for cannula removal and type of fluids and drugs infused, were recorded. Failure incidence was analysed by Cox's multivariate hazards model, life-table method and log rank tests. The results showed a highly significant difference (Chi 2 20.42, p < 0.0001) in decreasing infusion failure with the addition of low-dose heparin to infusate. Nursing implications could include a decrease in the incidence of extravasation and phlebitis, an increase in effective vein usage, fewer problems with i.v. flow rates, a reduction in medical/nursing hours associated with re-cannulations, less likelihood of systemic sepsis, and less patient worry and discomfort due to local venous reactions and re-cannulations.

Child↗

PubMed1997

Lack of overlap in genetic risks for Alzheimer's disease and Parkinson's disease.

We explored the question of genetic overlap between Alzheimer's disease (AD) and Parkinson's disease (PD) because evidence suggests clinical, pathologic, and epidemiologic overlap between the two disorders. We compared the frequency of AD and PD between the first-degree relatives of probands with AD and PD and first-degree relatives of spouse control subjects. Using life-table methods, we found increased risk of AD in first-degree relatives of patients with AD and an increased risk of PD in first-degree relatives of patients with PD. The risk of PD in first-degree relatives of patients with AD was not increased, nor was the risk of AD in first-degree relatives of patients with PD increased. These data do not support the hypothesis that important genetic overlap exists between AD and PD.

Aged↗

PubMed2005

Comparison of murine cirrhosis models induced by hepatotoxin administration and common bile duct ligation.

AIM: To build up the research models of hepatic fibrosis in mice. METHODS: Inbred wild-type FVB/N mice were either treated with alpha-naphthyl-isothiocyanate (ANIT), allyl alcohol (AA), carbon tetrachloride (CCl(4)), 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC), and silica, or subjected to common bile duct ligation (CBDL) to induce hepatic injury. Liver biopsies were performed every 4 wk to evaluate hepatic fibrosis over a period of 6 mo. Cumulative cirrhosis and survival curves were constructed by life table method and compared with Wilcoxon test. RESULTS: Under the dosages used, there was neither mortality nor cirrhosis in AA and silica-treated groups. DDC and ANIT caused cirrhosis within 4-12 and 12-24 wk, respectively. Both showed significantly faster cirrhosis induction at high dosages without significant alteration of survival. The duration for cirrhosis induction by CCl(4) ranged from 4 to 20 wk, mainly dependent upon the dosage. However, the increase in CCl(4) dosage significantly worsened survival. Intraperitoneal CCl(4) administration resulted in better survival in comparison with gavage administration at high dosage, but not at medium and low dosages. After CBDL, all the mice developed liver cirrhosis within 4-8 wk and then died by the end of 16 wk. CONCLUSION: CBDL and administrations of ANIT, CCl(4), and DDC ensured liver cirrhosis. CBDL required the least amount of time in cirrhosis induction, but caused shortened lives of mice. It was followed by DDC and ANIT administration with favorable survival. As for CCl(4), the speed of cirrhosis induction and the mouse survival depended upon the dosages and the administration route.

Animals↗

PubMed1995

Randomized trial of interferon maintenance in multiple myeloma: a study of the National Cancer Institute of Canada Clinical Trials Group.

PURPOSE: To determine whether interferon maintenance therapy improves overall survival and response duration in patients with multiple myeloma who have responded to induction therapy with melphalan and prednisone. PATIENTS AND METHODS: In a multicenter trial, patients with symptomatic clinical stage I and stage II and III multiple myeloma were registered at diagnosis and those who responded to melphalan-prednisone (MP) were randomized either to receive interferon (2 mU/m2) subcutaneously three times per week or no maintenance. MP was discontinued in both groups once a stable response plateau of the monoclonal protein was reached. Interferon was continued until relapse, and then was restarted on subsequent response to MP. Interferon toxicity was recorded using a self-report diary. Survival and response duration were calculated using life-table methods, and were adjusted in the analysis for imbalances in baseline prognostic factors. RESULTS: Four hundred two patients were registered and 176 responders were randomized (85 to interferon and 91 to control). At a median follow-up time of 43 months, the median survival duration was 43 months for interferon and 35 months for control (P = .16), but when adjusted for chance imbalances in baseline prognostic factors (mainly performance status), the median survival duration was 44 months and 33 months for interferon and control, respectively (P = .049). Progression-free survival from randomization to first relapse also favored interferon (unadjusted P < .002; adjusted P < .003). Interferon toxicity caused 58% of patients to reduce their dose, of which 84% were able to return to the initial dose; 14% had to discontinue interferon treatment. CONCLUSION: Interferon maintenance therapy improves progression-free and overall survival of patients with multiple myeloma who respond to melphalan and prednisone. Toxicity is substantial and must be weighed by patients against the potential benefits in response duration and survival.

Aged↗

PubMed1992

The use of the semen analysis in predicting fertility outcome.

The study investigates the use of the various parameters of the semen analysis in predicting the fertility outcome in 82 infertile couples. The sperm density, % progressive motility, % normal morphology were divided into 'normal' and 'abnormal' based on the criteria proposed by WHO. The subsequent cumulative pregnancy rates were then calculated according to this criteria. A life-table method of analysis was used. All female related fertility factors were excluded. With the exception of a sperm density of less than 20 x 10(6) per ml the other parameters showed no significant correlation with the cumulative pregnancy rates at 12 months or 24 months respectively. We concluded that the semen analysis does not predict the probable outcome of the subsequent rates even when female fertility related factors were excluded apart from a sperm density less than 20 x 10(6) per ml.

Female↗

PubMed1992

Prosthetic graft placement and creation of a distal arteriovenous fistula for secondary vascular reconstruction in patients with severe limb ischemia.

Patients with lower limb ischemia who require reoperation for failed vascular reconstructive surgery can benefit from a surgical technique in which an artificial graft is used and an arteriovenous fistula is created at the site of the distal anastomosis, followed by ligation of the proximal vein. This technique was used in 30 patients who had undergone vascular reconstruction with bypasses from the femoral to the distal tibial, peroneal, or dorsal pedal arteries. Angiography showed occlusion of the superficial femoral and popliteal arteries in all patients with reconstitution of only one small segment in the anterior tibial (n = 12), posterior tibial (n = 11), peroneal (n = 5), or dorsal pedal artery (n = 2). All patients had rest pain and necrosis. Artificial grafts were required because of the absence of autogenous vein. Immediate postoperative graft patency was achieved in all 30 patients. The mean ankle/arm pressure index increased from 0.30 +/- 0.24 to 0.79 +/- 0.31 (p less than 0.01). Graft patency computed by the life-table method was 71% at both 1- and 2-year follow-up. Foot salvage was achieved in 25 of 30 patients after surgery. The results of this study indicate that an aggressive vascular surgical approach in patients with severe ischemia and previous failed bypass procedures is justified. In the absence of autogenous vein, the combination of a prosthetic graft and a distal arteriovenous fistula with ligation of the proximal vein increases graft patency.

Adult↗

PubMed2004

Long-term survival of Japanese patients transported to an emergency department because of syncope.

STUDY OBJECTIVE: Cardiovascular disease mortality is affected by ethnic differences and is lower in Japan than in Western countries. Although patients with cardiac syncope have significantly higher mortality than patients with noncardiac syncope in Western countries, no such phenomenon has been described in Japan. The aim of this study is to clarify the long-term mortality of patients with syncope who are brought to an emergency department (ED) in Japan. METHODS: This retrospective observational study was conducted on patients treated in the ED of Keio University Hospital in Tokyo. Nine hundred twelve consecutive patients who presented with syncope were identified. The patients were classified into 2 groups according to the cause of syncope: cardiac syncope and noncardiac syncope. Follow-up information about mortality was obtained from mailed questionnaires and medical records. Mortality data were analyzed using the actuarial life-table method and a Cox proportional hazards model. RESULTS: Follow-up information was obtained for 715 patients. The median follow-up period was 38 months, during which 63 patients died. At 5 years, the 23.1% (95% confidence interval [CI] 12.7% to 33.4%) mortality of the patients with cardiac syncope was significantly higher than the 8.2% (95% CI 5.5% to 10.9%) mortality of the patients with noncardiac syncope (P<.0001). The incidence of cardiac death among the patients with cardiac syncope was 17.2% (95% CI 7.8% to 26.5%) compared with 0.9% (95% CI 0% to 1.8%) in the noncardiac syncope group (P<.0001). Cardiac syncope was an independent predictor of overall mortality and cardiac mortality (relative risk 2.81 [95% CI 1.53 to 5.16], 18.74 [95% CI 5.90 to 59.52]). CONCLUSION: Cardiac syncope is associated with higher mortality than noncardiac syncope in this Japanese patient population.

Adolescent↗

PubMedDate not supplied

Manual thromboaspiration and dilation of thrombosed dialysis access: mid-term results of a simple concept.

PURPOSE: To report the feasibility, safety, and effectiveness of manual thromboaspiration as a single means of declotting dialysis access. MATERIALS AND METHODS: Between April 1994 and December 1996, 59 consecutive conduits (43 polytetrafluoroethylene [PTFE] grafts, 16 native fistulas) were declotted with 8-F or 7-F angulated catheters. Unmasked stenoses were dilated. Clinical and paraclinical nephrologic surveillance (poor flow, palpation, difficulties with cannulation, increased compression times, increasing venous pressures) led to redilations and stent placements. Rethromboses were treated with further declotting by aspiration. The results are presented according to the life-table method. RESULTS: The initial success of 43 of 43 PTFE grafts (mean procedure time, 119 min +/- 29 [standard deviation]) led to a primary patency rate of 85% +/- 5% (SE) at 1 month, 33% +/- 8% at 6 months, and 24% +/- 12% at 1 year. A graft was ligated 6 days after declotting for acute bleeding in one patient given high-dose warfarin. The secondary patency rates were 86% +/- 7% at 6 months and 86% +/- 9% at 1 year, with a mean duration of patency of 5.7 months between two radiologic interventions performed to maintain or to restore patency, and 19 stents were placed at a mean follow-up of 3 months. The success rate was 81% for native fistulas, with primary patency rates of 81% +/- 10% at 1 month, 74% +/- 14% at 6 months, and 60% +/- 27% at 1 year; secondary patency rates of 81% +/- 12% at 6 months and 81% +/- 18% at 1 year. CONCLUSION: Thromboaspiration is a safe and effective method for declotting dialysis access, yielding a low rethrombosis rate during the first month. Overall radiologic management with reintervention on average every 6 months results in high secondary patency rates at 1 year (81%-86%).

Adult↗