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At least 1,063 records · Page 59Linked to original sources

PubMed2000

[Risk stratification after myocardial infarct].

In industrialized countries the rate of sudden cardiac death remains unchanged. The most frequently encountered structural heart disease in these patients is coronary artery disease. Despite the era of thrombolytic therapy of acute myocardial infarction patients carry an increased risk of sudden cardiac arrhythmogenic death within a time period of one to two years following the acute event. Therefore, risk stratification post-MI before patient discharge is furthermore mandatory. The spectrum of non-invasive techniques for risk stratification includes the clinical risk profile, measurement of left ventricular global function (LV ejection fraction), the resting ECG (QT dispersion), an ECG stress test (detection and severity of myocardial ischemia), ambulatory ECG monitoring (number and type of ventricular arrhythmias), surface high resolution ECG (detection of ventricular late potentials), measurement of T wave alternans (TWA, alternans ratio), and measurements of the activity and balance of the autonomous nervous system (heart rate variability, baroreflex sensitivity = BRS). Programmed ventricular stimulation (PVS) serves as an invasive risk stratification technique (detection of an arrhythmogenic substrate). The prognostic power of the non-invasive techniques is limited; in general, the prognostic value of a negative test is reasonably high (90 to 100% depending on the test used), whereas the prognostic value of a positive test is rather low (4 to 42% depending on the test used). Combining several non-invasive tests may significantly improve the positive predictive value above 50%, but this goes along with a significant decreases of sensitivity below 50%. Therefore, a combination of several non-invasive tests (detection and exclusion of a large number of low-risk individuals) with the invasive method of PVS (detection of an arrhythmogenic substrate, i.e. a high-risk patient) seems reasonable, as has been convincingly shown by several smaller prognostic studies.

Arrhythmias, Cardiac↗

PubMed1998

[Treatment of humeral fractures by Marchetti nailing. Apropos of 45 cases].

Between 1995 and 1997 we implanted 45 Marchetti nails. These nails were implanted for traumatic fractures in 39 patients, but also for pathologic fractures in 5 patients. Among these 39 patients, 7 were lost of view, the average age was 60 years. Among these 39 patients, 4 have got an other treatment before which failed. 10 fractures were placed D1, 8 fractures placed D2, 5 fractures placed D3, 16 fractures placed D4 according to the classification of Hackethal modified by De la Caffinière. The fracture type was classified according to A. O. classification: 7 A1, 11 A2, 7 A3, 2 B1, 6 B2, 1 B3, 4 C1, 1 C2. Among the 32 patients reviewed with an average of follow-up of 11 months, we have observed 5 very good results, 14 good results, 6 passable results and 3 bad results (classification of Stewart and Hundley). The average length of consolidation was 3 months. At follow-up the average elbow mobility was 129 degrees. Among the 3 bad results, there were 2 pseudarthrosis, in D4 zone. We have got 3 supracondylar fractures during the removal of the nail and 2 impactions of the metaphysis fracture. 5 patients had a nailing for pathologic fractures, one of them bilateral (4 women and one man, average age 65 years). Only two patients were reviewed, the fracture healed without any difference with the traumatic group. Contrary to other nailing, this materiel respects the rotator cuff. The global functional result was good.

Adolescent↗

PubMedDate not supplied

[Extent of law compliance and anti-smoking teaching at Spanish schools].

OBJECTIVE: Knowing the degree of fulfillment of the anti tobacco legislation in Spanish schools and the influence that this has on the percentage of smoking pupils. MATERIAL AND METHODS: A survey was carried out among 3050 headmasters of Spanish schools, who were asked about different aspects of the fulfillment of the antitobacco laws in their schools and about the main characteristics of tobacco consumption in their centers. RESULTS: A 80.9% of the headmasters claim that the fulfillment of the legislation is demanded in their centers, and only a 64.9% of them have posters in theirs schools that warn people about smoking ban. Anti tobacco teachings are imparted in a 82.2% of the schools where laws is demanded and only in a 64.8% where is not demanded. The percentage of teachers who, smoke in the presence of the pupils is of a 5.9% in the schools where anti tobacco legislation is demanded and a 12.9% where is not demanded. In the schools where anti tobacco teachings are imparted, a 29% of the pupils have tried tobacco, opposite a 31% who have tried in the schools where these teachings are not imparted. CONCLUSIONS: The, headmasters of the schools, as people in charge of watching over the fulfillment of the anti tobacco legislation in theirs schools, must demand the fulfillment of this one, because this measure is effective in order to improve the global functioning of the schools and to reduce the percentages of smoking pupils and teachers.

Curriculum↗

PubMed2001

[Effect of postinfarct left ventricular dysfunction on late occurrence of mitral regurgitation--two year experience].

The aim of this study was to evaluate factors that might influence on the occurrence of mitral regurgitation (MR) in patients (pts) following myocardial infarction (MI) after fibrinolysis--two year experience. The study group comprised 118 pts: 40 women and 78 men (mean age: 58 +/- 9 years) following MI, who underwent Doppler echocardiography which revealed no MR 3 weeks after the MI. The second echocardiographic examination was performed after 2 years. We evaluated the following parameters: presence and stage of MR, left ventricular end-diastolic diameter (LVDD), left atrial diameter (LA), end-diastolic volume (EDV), wall motion score index (WMSI), asynergic area (AA) and ejection fraction (EF). Results after 2 years were as follows: 43 pts (36%) presented without MR, 45 (38%) MR I degree, 27 (23%) MR II degree, 3 (3%) MR III degree. Echocardiographic parameter comparison after 2 years demonstrated the following changes: LVDD increase from 5.0 +/- 0.5 cm to 5.3 +/- 4.6 cm (p < 0.005), LA increase from 3.7 +/- 0.4 cm to 4.3 +/- 0.4 cm (p < 0.00001), EDV increase from 130 +/- 29 ml to 147 +/- 39 ml (p < 0.005), WMSI increase from 1.37 +/- 0.23 to 1.45 +/- 0.21 (p < 0.05), AA increase from 23.5 +/- 10.1% to 27.8 +/- 7.9% (p < 0.005) and significant EF decrease 50.4 +/- 7.9% to 46.9 +/- 7.1% (p < 0.005). These results demonstrate that the occurrence of MR 2 years after the MI is caused by left ventricular remodelling, as well as segmental and global function deterioration.

Adult↗

PubMed2002

Selective electrical silencing of mammalian neurons in vitro by the use of invertebrate ligand-gated chloride channels.

Selectively reducing the excitability of specific neurons will (1) allow for the creation of animal models of human neurological disorders and (2) provide insight into the global function of specific sets of neurons. We focus on a combined genetic and pharmacological approach to silence neurons electrically. We express invertebrate ivermectin (IVM)-sensitive chloride channels (Caenorhabditis elegans GluCl alpha and beta) with a Sindbis virus and then activate these channels with IVM to produce inhibition via a Cl- conductance. We constructed a three-cistron Sindbis virus that expresses the alpha and beta subunits of a glutamate-gated chloride channel (GluCl) along with the green fluorescent protein (EGFP) marker. Expression of the C. elegans channel does not affect the normal spike activity or GABA/glutamate postsynaptic currents of cultured embryonic day 18 hippocampal neurons. At concentrations as low as 5 nm, IVM activates a Cl- current large enough to silence infected neurons effectively. This conductance reverses in 8 hr. These low concentrations of IVM do not potentiate GABA responses. Comparable results are observed with plasmid transfection of yellow fluorescent protein-tagged (EYFP) GluCl alpha and cyan fluorescent protein-tagged (ECFP) GluCl beta. The present study provides an in vitro model mimicking conditions that can be obtained in transgenic mice and in viral-mediated gene therapy. These experiments demonstrate the feasibility of using invertebrate ligand-activated Cl- channels as an approach to modulate excitability.

Action Potentials↗

PubMed2002

[A 7-year follow-up study of cases with dementia to identify predictors of mortality].

OBJECTIVES: To identify factors associated with mortality in cases with Alzheimer's disease (AD) and vascular dementia (VD), we conducted a seven-year follow-up study. METHODS: Subjects were recruited through three agents in Yamanashi prefecture. A total of 145 patients (56 men, 89 women, age at baseline 77 +/- 7.9, 80 +/- 8.5 years respectively) with AD and VD participated in the follow-up study. We analyzed the relationship between demographic or clinical variables and their survival using a Cox regression model. RESULTS: The analysis revealed that increased age, male gender, the degree of global function and past history of a fall/fracture were associated with a decreased survival rate. The rate was worse for patients with VD than for those with AD. After adjusting for age and gender, the mortality risk ratio was 1.7 (95% confidence interval 1.1-2.6) for the presence of a fall/fracture. The same analysis confined to 64 subjects for whom ApoE genotyping data were available replicated the results; a fall/fracture was a predictor of a worse survival rate. In addition, those with ApoE4 tended to have better survival rate than those without (P < 0.1). CONCLUSION: Those who are engaged in care for AD patients should appreciate the importance of a fall/fracture as a predictor of survival.

Aged↗

PubMed2002

Ecotoxicology and ecosystems health.

There is mounting evidence that traditional investigations are no longer sufficient either to assess the ecological characteristics of a resource or to better understand the dynamics of an ecosystem. Reliable experimental data to be used for further investigation as well as for environmental corrective action are obtained using the traditional quantitative and qualitative biological methods. In fact, environmental health is connected with well functioning global and local ecological cycles, that also assure renewable, good quality natural resources. There is, therefore, a keen need for new, adequate techniques based on biological parameters that will allow for a better understanding and protection of the environment. The use of biological indexes and indicators and toxicology tests have been also prescribed by a recent Italian law on water protection. Differences between toxicology, environmental toxicology and ecotoxicology, often used as equivalent terms, are also analyzed. Furthermore a new classification is proposed and mapping of ecobiotic and toxicologic data on studying waters in river basins.

Biology↗

PubMed1999

[Symptom severity among chronic schizophrenics in hospital and in the community].

We compared severity of symptoms of chronic schizophrenics in a psychiatric hospital with those treated in its outpatient clinics. The Positive and Negative Syndrome Scale and the Mini-Mental State examination were used to assess the schizophrenic symptoms and cognitive performance, respectively, of 25 chronic schizophrenic inpatients matched for gender, age and education with 25 chronic schizophrenic outpatients. The Global Assessment Scale and the Clinical Global Impression Scale were used to test global functioning. Assessment included psychiatric and medical history and treatment and demographic characteristics. In-patients had significantly more positive, negative and general psychiatric symptoms. Their cognitive and general functioning were impaired. Most in-patients also had medical problems. Age of onset of schizophrenia among the in-patients was younger. Results show a marked difference in severity of symptoms and level of functioning between chronic schizophrenic in-patients and out-patients. These differences should be considered in the planning of discharge of chronic in-patients from psychiatric hospitals into the community.

Humans↗

PubMed2002

[Organizational and managerial model for the patient with chronic heart failure].

Patients with chronic heart failure show a range of care and global therapeutic management problems. The main elements for an efficient management are: hospital-territory integration based on a structured mode of operating and on the healthcare professional/patient relationship; rational continuity in the treatment; multi-disciplinarity of the interventions; the patient's active participation. In the light of these considerations the authors report their own direct experience describing the organizational and management model for patients with chronic heart failure during the various phases of treatment, from the global functional evaluation and treatment program to homecare management integrated with the general practitioner.

Aged↗

PubMed2003

Galantamine: a review of its use in Alzheimer's disease and vascular dementia.

Dementia has the potential to become a major public health concern during this century due to increasing life expectancy and growth in the ageing population. The commonest types of dementia include Alzheimer's disease (AD), vascular dementia (VaD), and dementia with cerebrovascular components. Galantamine is the only acetylcholinesterase inhibitor that exhibits a dual mechanism of action--inhibition of acetylcholinesterase and nicotinic receptor modulation. Clinical studies demonstrate the efficacy and safety of galantamine in patients with AD, VaD, and AD with cerebrovascular components. Galantamine shows beneficial effects on cognition, global function, activities of daily living and behaviour. Adverse events observed with galantamine use are generally mild to moderate in severity, transient and gastrointestinal in nature. The dose of galantamine should be escalated to 16 and 24 mg/day at four-week intervals to achieve maximal tolerability. Because of its unique mechanism of action, galantamine may have potential benefits over conventional enzyme-inhibiting agents.

Alzheimer Disease↗

PubMedDate not supplied

Cross sectional echocardiographic left ventricular ejection fraction: method based variability.

Cross-sectional echocardiographic left ventricular ejection fraction (LVEF) by five different Methods (Teichholz, Area-length, single-plane Simpson, Bullet and Baran Formulae) was determined in 24 normal healthy volunteers (male-17, female-7, age range 16-80 years, mean 37 +/- 13) to assess the method-dependent variability in left ventricular volumes and LVEF. Although the Teichholz and Bullet methods gave somewhat higher values, there was no significant difference between LVEF determined by any of the methods (F = 0.16, p greater than 0.50). There was an a symmetrical distribution of LVEF in this normal group with an absolute mean positive skewness of 6 per cent (range 4-7 percent, coefficient of skewness = +0.43 to +0.87). A cut-off normal lower limit of LVEF at 50 per cent encompassed 88-100 per cent (mean 93.3) of subject population depending upon the method used. Similarly there was no significant difference between left ventricular volumes obtained by various methods. Therefore all the above five methods for quantitation of left ventricular global function are equally useful in clinical studies in patients with normal left ventricular geometry and in absence of segmental asynergy.

Adolescent↗

PubMed2003

[Thalamo-cortical dysrhythmia syndrome: neuropsychiatric features].

One of the essential aspects of the neuronal organization in the global function of the brain is the rich thalamocortical interconnectivity and very particularly the reciprocal nature of this circuit. Also, the interaction between the systems specific thalamic and unspecific at cortical level suggests that the thalamus, more than a simple floodgate for the brain, represents an epicentre by means of which all the cortical areas can communicate to each other in isochronic way with independence of the transcortical distance. The objectives of this article are to explore: 1) the proposal that the temporary coincidence, to great scale, of the activity specific thalamic and unspecific generates the functional states that characterize the human knowledge; and 2) the possible relationship between the thalamocortical dysrhythmia and some neuropsychiatric illnesses.

Brain Diseases↗

PubMed2004

Treating autistic spectrum disorders in children: utility of the cholinesterase inhibitor rivastigmine tartrate.

Rivastigmine tartrate is a dual-action cholinesterase inhibitor shown to improve language, cognition, and global functioning in patients with Alzheimer's disease, likely via increased availability of cerebral acetylcholine. Because cholinergic receptor abnormalities can contribute to the neuropathology of autistic spectrum disorders, rivastigmine tartrate could prove to be an effective therapy for affected children. Observations of improved behavior and language output from prior open-label and double-blind treatment of autistic children with donepezil, another cholinesterase inhibitor, prompted this 12-week open-label study with rivastigmine tartrate of 32 autistic patients. Therapeutic indices were the Childhood Autistic Rating Scale, Gardner's Expressive and Receptive One-Word Picture Vocabulary tests, and the Conners' Parent Rating Scale. Testing administered at baseline, 6 weeks, and 12 weeks showed gains in both expressive speech and overall autistic behavior over baseline. These improvements were statistically significant and supported the hypothesis that treatment with cholinergic enhancing drugs in autistic spectrum disorders yields positive therapeutic effects.

Acetylcholine↗

PubMed2004

A linear programming approach to limited angle 3D reconstruction from DSA projections.

OBJECTIVES: We investigate the feasibility of binary-valued 3D tomographic reconstruction using only a small number of projections acquired over a limited range of angles. METHODS: Regularization of this strongly ill-posed problem is achieved by (i) confining the reconstruction to binary vessel/non-vessel decisions, and (ii) by minimizing a global functional involving a smoothness prior. RESULTS: Our approach successfully reconstructs volumetric vessel structures from three projections taken within 90 degrees. The percentage of reconstructed voxels differing from ground truth is below 1%. CONCLUSION: We demonstrate that for particular applications--like Digital Subtraction Angiography--3D reconstructions are possible where conventional methods must fail, due to a severely limited imaging geometry. This could play an important role for dose reduction and 3D reconstruction using non-conventional technical setups.

Angiography, Digital Subtraction↗

PubMed1992

[Analysis of coagulation factor XIII in Crohn's disease--establishment of a novel monoclonal anti-coagulation factor XIII antibody].

A novel monoclonal anti-human coagulation factor XIII (F. XIII) antibody (2C3 antibody) raised in BALB/c mice was established by Kohler and Milstein methods. The monoclonal antibody recognized F. XIII of 85 KD demonstrated by western blotting analysis. Plasma F. XIII-IR levels measured by ELISA with 2C3 antibody were significantly lower in active disease than in quiescent disease in a total of 21 Crohn's disease (CD) patients. Plasma F. XIII levels were significantly lower on admission in CD with fistulas than in CD without fistulas. Relationships between activities of CD and plasma F. XIII levels were shown. No significant relationships, however, were observed between F. XIII-IR levels and nutritional states assessed by TP, ALB, TF, PA, RBP, %IBW. Low levels of F. XIII in active CD patients with fistulas may occur regardless of hyponutrition. By using 2C3 antibody, global functions of F. XIII will become clarified as well as pathologic and diagnostic roles of plasma F. XIII in CD.

Adolescent↗

PubMed2005

The present role of nuclear cardiology in clinical practice.

Many advances have been made in the field of nuclear cardiology in the past decade for enhancing the diagnostic and prognostic value of stress myocardial perfusion imaging and the assessment of myocardial viability using SPECT technology. Gated SPECT for determining regional and global function have provided incremental diagnostic and prognostic information in the evaluation of patients with suspected or known coronary artery disease. Left ventricular ejection fraction and regional myocardial wall thickening can now be simultaneously evaluated with regional perfusion particularly with the use of the (99m)Tc-labeled perfusion agents such as sestamibi and tetrofosmin. Many studies have shown that the extent and severity of stress-induced perfusion defects have incremental prognostic value over exercise electrocardiographic stress test variables alone. Patients with normal perfusion scans have <1% combined cardiac death and myocardial infarction rates per year and thus have an excellent prognosis. Diabetics are particularly benefited from stress perfusion imaging for detection of coronary artery disease and risk assessment. Diabetics have a worse prognosis than nondiabetics for the same amount of hypoperfusion on stress SPECT studies. Quantitative rest perfusion imaging with (201)Tl or with one of the (99m)Tc-labeled imaging agents, or PET imaging with (18)F-deoxyglucose can accurately distinguish viable from irreversibly injured myocardium providing useful information for identifying which patients with ischemic cardiomyopathy benefit most from coronary revascularization with a subsequent improvement in left ventricular function and enhanced survival. Finally, serial stress perfusion imaging can be employed to monitor the efficacy of medical therapy that improves endothelial function and myocardial blood flow reserve.

Cardiology↗

PubMed2005

Cholinesterase inhibitors in the treatment of dementia.

Dementia associated with probable Alzheimer's disease (AD) is one of the most common types of dementia. Patients with AD often have cholinergic deficits in association with the disease. The cholinesterase inhibitors donepezil hydrochloride, galantamine hydrobromide, and rivastigmine tartrate are the current mainstays of symptomatic treatment for patients with AD. In clinical trials for all three agents, beneficial effects on standard measures of cognitive and global function have been observed in patients with mild to moderate AD. Although none of the cholinesterase inhibitors has been approved for treatment of patients in advanced stages of AD, all three agents have had beneficial cognitive effects among patients with less severe forms of the disease. The author provides information on recommended dosing for all three medications, noting that cholinesterase inhibitors must be titrated carefully. When administered with caution, galantamine, rivastigmine, and donepezil are generally well-tolerated pharmacologic treatment options. The author notes that, after patients and their caregivers understand that no change in status is considered an "improvement" and a desirable clinical outcome for patients with AD, if no benefits are achieved with the use of one cholinesterase inhibitor, switching to another medication in this class might be beneficial. The author further suggests that the benefits found in cholinesterase inhibitors for patients with AD might also be applicable to patients with other types of dementia such as vascular dementia and dementia with Lewy bodies as cholinergic deficits have been reported in association with these types of dementia as well.

Acetylcholine↗

PubMed1992

[Introduction of the Valduna-Reha Scale].

We present a rating scale for the progress in rehabilitation which has been developed and tested in the course of several years. It is of special suitability for the documentation of rehabilitation in cases of dysfunction of the central nervous system due to various syndromes arising from vascular, post-traumatic and post-operative causes. It comprises the essential somatic as well as psychological data and differentiates between specific (e.g. localised) symptoms and their effects on the individual's global functioning, especially within his (her) social sphere. Under this aspect our scale appears to be of optimal use, especially with regard to the requirement: "as simple as possible and as comprehensive as necessary". It modifies the criteria of the WHO regarding the threefold differentiation between impairment, disability and handicap, by the use of two levels of documentation, thereby gaining in validity.

Activities of Daily Living↗