SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In 22 patients with deep venous insufficiency thermography performed at rest and immediately after exercise was compared with conventional ascending phlebography. Thermography was found to have a high sensitivity in detecting incompetent perforating veins, while the specificity was low. The non-invasive thermography is an attractive technique for preoperative detection of perforating veins.
The competitive elite athlete who sustains an anterior cruciate ligament (ACL) rupture has few options for treatment. If they wish to continue to compete at the preinjury level, then the only viable option is to undergo an ACL reconstruction. Otherwise, the athlete is at a substantial risk with a ACL deficient knee of sustaining subsequent degenerative changes in the knee at a young age. The athlete's presentation following injury includes reporting of a contact or noncontact acceleration or deceleration twisting injury to the knee, a 'pop' or the sensation of the joint 'coming apart', haemarthrosis, a positive Lachman test, loss of extension, and a positive pivot shift test. A magnetic resonance image may be used as an adjunct in the diagnosis. Treatment of the patient with an acutely injured ACL rupture begins with the first report of injury and continues until the patient has regained full strength and range of motion. The timing of the surgery depends on both the patient's physical and mental recovery from the acute injury. There are various surgical techniques employed in the ACL reconstruction: repair through the patellar defect, arthroscopically assisted techniques, and the miniarthrotomy technique we use. These techniques all give both excellent and reproducible results. A major emphasis is now placed on the preoperative and postoperative rehabilitation with an ACL reconstruction. An accelerated and aggressive programme which relies on early return and maintenance of full hyperextension equal to the contralateral knee, early weight bearing, and closed kinetic chain exercises is recommended. The programme is divided into 3 phases with each phase having specific goals to be met before proceeding to the next phase.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of the PERISCOP study was to evaluate the predictive value of cardiological investigations performed after recent coronary bypass surgery with regards to cardiac event and mortality at one year. The treatment of lipid abnormalities was also analysed. This first article describes the methodology and patient characteristics at inclusion. This prospective national multicenter trial included 2065 patients (86% men) with an average age of 63.1 +/- 9.9 years. The number of diseased vessels was 2.6 +/- 0.6. Preoperative left ventricular function was normal (ejection fraction 60 +/- 13%). Revascularisation was complete in 73% of cases (22% of arterial grafts). The cardiological investigations were performed at Day 20 +/- 10 after surgery. The duration of exercise on stress testing was 429 +/- 170 seconds. It was positive or doubtful in 9% of cases. Ventricular arrhythmias were observed in 6.5% of cases. The blood pressure response was abnormal in 6% of cases. Holter monitoring showed a median number of ventricular extrasystoles over 24 hours of 44. Three per cent of patients had one episode of ventricular tachycardia and 7% had ischaemic episodes. The echocardiographic index of segmental contractility was on average 1.75 (ejection fraction: 52.6%). The lipid analysis performed at one month, under lipid therapy in 34% of cases, showed a total cholesterol level at 1.91 +/- 0.10 g/l, an LDL-cholesterol of 1.27 +/- 0.08 g/l. The therapeutic target (LDL-cholesterol < 1 g/l) was attained in 46% of cases with treatment and in 18% of cases without treatment.
BACKGROUND: Cosmetic deformity and psychological repercusion are the main surgical indications in pectus excavatum. However cardiopulmonary function is subclinically abnormal in some patients. The goal of this paper is to demonstrate that heart response during physical activity improves after surgical correction of pectus excavatum. PATIENTS AND METHODS: Fifty five patients were operated upon for pectus excavatum during the last 10 years at our institution. Baseline ecocardiography and isometric effort test (Handgrip) were preoperatively performed in 15 patients (11 males and 4 females) aged from 6 to 15 years (median 9,63). An increase below 12% in cardiac index was considered as positive. In those patients with positive tests, a new test was made 6 months after surgical correction. Pre and postoperative results were compared using non-parametric tests. RESULTS: Baseline cardiac index values were normal in all cases (11). Four patients were not included, 2 because of no collaboration (aged 6 and 7 years) and 2 because difficult ecocardiography interpretation (both operated upon for congenital diaphragmatic hernia). Overall, preoperative test was negative in 6 patients and positive in the remaining 5. Postoperative test was made in these 5 patients, and all of them showed an improvement in cardiac index (medium 40,6%, range 25-70) when compared to preoperative values. There was statistically significant association between test values and patient ages. CONCLUSIONS: Baseline cardiac index values were normal in children with pectus excavatum, albeit 45,5% of them showed a limited response to exercise. Pectus excavatum repair improves these values, so physiopathological indication as well as cosmetic one should be considered specially in children.
Although pulmonary regurgitation is generally well tolerated, reconstruction of the right ventricular outflow tract and insertion of a pulmonary valve are indicated in some patients. This procedure was performed in 12 patients, ages 1 1/2-17 years (mean 10 years). Seven had tetralogy of Fallot; of these, one underwent primary repair with Glenn shunt takedown and six underwent repeat operations after previous repairs. Of these six, the major indication for reoperation was right ventricular outflow tract obstruction in four, tricuspid and pulmonary regurgitation in one, and a residual ventricular septal defect and patent shunt in one. Three had absent pulmonary valve syndrome and two had pulmonary atresia. There were no early complications or deaths in this series during a mean follow-up of 28 months. Repeat cardiac catheterization was performed in eight patients and revealed that the preoperative right ventricular-pulmonary artery gradient was reduced from 58 +/- 25 mm Hg to 11.6 +/- 7 mm Hg at rest postoperatively and was located at the level of the valve. This gradient increased with exercise or isoproterenol infusion to 31 +/- 9 mm Hg. Our experience suggests that right ventricular outflow tract reconstruction with porcine valve insertion can be safely performed with good hemodynamic results. This technique allows insertion of a larger porcine valve and avoids kinking and compression of a conduit behind the sternum.
OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.
INTRODUCTION: Single lead VDD pacing has offered an alternative to DDD systems in patients with isolated AV block. Up to now, however, the relative performance of these pacemaker systems was not systematically compared. METHODS AND RESULTS: Three hundred sixty patients who received either a VDD pacemaker (n = 180) or a DDD device (n = 180) with a bipolar atrial lead were investigated prospectively for a mean period of 30 +/- 13 months. Pacemaker function was analyzed by telemetry, Holter monitoring, and exercise ECG. Time of implantation and fluoroscopy was significantly lower with VDD devices (44.3 +/- 5.1 min vs 74.4 +/- 13.5 min and 4.6 +/- 2.5 min vs 10.3 +/- 5.6 min in DDD pacemakers, respectively). Intermittent atrial undersensing occurred in 23.3% of patients with a VDD pacemaker and in 9.4% with DDD devices (NS). The incidence of atrial tachyarrhythmias did not differ between the VDD (6.7%) and the DDD group (6.1%). Sinus node dysfunction developed in 1.9% of patients, but the vast majority (85.7%) of patients were asymptomatic. There was a tendency for a higher rate of operative revisions in the DDD group (6.1% vs 3.3% in VDD pacemakers, P = 0.15). Cumulative maintenance of AV-synchronized pacing mode was 94.9% in patients with VDD pacemakers and 92.1% with DDD devices (NS). CONCLUSION: With the benefit of a simpler implant procedure, long-term outcome of single lead VDD pacing is equivalent to DDD pacing in patients with AV block and preoperative normal sinus node function.
Surgical correction of stress incontinence in the female remains a complex and distressing problem. Just as there is no single etiologic factor present in all patients with stress incontinence, so ther is no single uniformly corrective operative procedure, as attested by the continued reports of new operative techniques or malfunctions of old procedures. Every therapeutic effort for stress incontinence, whether by means of medication, exercise, plication, suspension, sling, or some combination of these, effectively increases urethral resistance by tightening the musculofasical planes and supporting the urethra. Regrettably, none of these methods can be 100% effective. The patient who does not have good urethral smooth muscle, qualitatively and quantitatively, will remain incontinent. Regardless of its length, caliber, angle, or axis, a fixed, fibrotic, noncontractile urethra will not provide urinary control. I prefer to use the Marshall-Marchetti-Krantz procedure in patients who had previous operatons and have persistent or recurrent incontinence.
Myocardial viability can be defined as functional improvement of dysfunctional myocardium after revascularization. The purpose of this study was to define the optimal criteria for definition of regional functional improvement after coronary artery bypass graft (CABG) surgery on quantitative gated single-photon emission tomography (SPET). Thirty-two patients (26 men, 6 women; age 56 +/- 13 years) with coronary artery disease (three-vessel disease, 17; two-vessel disease, 15; previous history of myocardial infarction, 9) and severe left ventricular dysfunction (LVEF < or = 35%) underwent CABG. Rest thallium-201/dipyridamole stress technetium-99m methoxyisobutylisonitrile gated myocardial SPET was performed before and 3 months after CABG. Global LV functional improvement was defined as either an improvement in LVEF of 10% ( n = 15) or an improvement in LVEF of 5% combined with a decrease in end-systolic volume of 10 ml ( n = 2) after CABG on quantitative gated SPET. Postoperative regional wall thickening improvement (DeltaRWT), regional wall motion improvement (DeltaRWM) and regional resting (DeltaRP) and stress perfusion improvement (DeltaRstrP) were used to determine global functional improvement by ROC curve analysis, and the optimal criteria for definition of viable regional dysfunctional myocardium were defined on the ROC curves. Correlations were verified by determining the number of improved myocardial regions and LVEF improvement. LVEF was improved from 25% +/- 6% to 34% +/- 11% after CABG. A total of 229 segments were dysfunctional (wall motion < or = 2 mm, thickening < or = 20%) before CABG. On ROC curve analysis using global functional improvement as an indicator of viability, the areas under the ROC curves (AUCs) of DeltaRWT and DeltaRWM were 0.717 and 0.620, respectively. The AUC of DeltaRWT was significantly larger than that of DeltaRWM ( P = 0.009) and the optimal cut-off value of DeltaRWT was 15%. The AUCs of DeltaRP and DeltaRstrP were not significant. The correlation coefficients between summed DeltaRWT and DeltaRWM and LVEF improvement were 0.591 and 0.472, respectively. The number of segments with a DeltaRWT of more than 15% correlated with LVEF improvement (rho = 0.533 by Spearman rank correlation). Regional wall thickening improvement showed the best correlation with global LV functional improvement after CABG. The most reliable regional criterion of myocardial viability was improvement in regional wall thickening by > or = 15% on quantitative gated SPET.
The efficacy of a systematic regimen of rehabilitation of mandibular function after ramus osteotomy was investigated. Forty-eight patients who had had either sagittal split ramus osteotomy to advance the mandible or intraoral vertical ramus osteotomy to retract the mandible were studied; 24 patients received rehabilitation and 24 did not. Pre- and postsurgical maximal mandibular opening, lateral and protrusive mandibular movements, maximum bite force, muscle fatigability, and clinical evaluation of the temporomandibular joints were compared between the two groups. Patients who underwent an intraoral vertical ramus osteotomy did not show a significant decrease in any of the parameters measured whether or not rehabilitation was used. However, patients who underwent sagittal split ramus osteotomies without subsequent rehabilitation had significant decreases (P less than 0.05) in mean mandibular opening and bite force as well as increases (P less than 0.05) in muscular fatigability compared with patients who underwent rehabilitation. These findings indicate the need for routine preoperative evaluation of mandibular and temporomandibular joint function and postsurgical physical rehabilitation after ramus osteotomies.
OBJECTIVES: This study was conducted to describe the incidence of ventricular arrhythmia during prospective long-term follow-up in a group of patients who had repair of tetralogy of Fallot during early childhood. BACKGROUND: Ventricular arrhythmia has been a common finding in patients who have undergone repair of tetralogy of Fallot in late childhood or as adults. Whether earlier repair lowers the incidence of late ventricular arrhythmia or late sudden death is unknown. METHODS: Twenty-nine asymptomatic patients who underwent repair at age 1.2 to 7.7 years (mean [+/- SD] age 4 +/- 1.4 years) between 1979 and 1984 were studied. Twenty-one patients had simple repair (Group A), and eight had complex or multiple operations (Group B). All had ambulatory electrocardiographic monitoring preoperatively, postoperatively, at early follow-up (after 4.2 +/- 1.3 years) and again at late follow-up (after 11.8 +/- 1.3 years). At late follow-up, 28 subjects also underwent echocardiography, and 26 had an exercise test. RESULTS: No patient had significant ventricular arrhythmia (> or = modified Lown grade 2) before or immediately after repair. There was no significant increase in the incidence of arrhythmia at early and late follow-up (14% to 28%), but at each of these periods the incidence of ventricular arrhythmia was higher in Group B patients (3 [43%] of 7 vs. 1 [5%] of 22 with early repair, p = 0.03; 6 [75%] of 8 vs. 2 [10%] of 21 with late repair, p = 0.001). No patient had symptoms of arrhythmia, and there were no sudden deaths. Late ventricular arrhythmia did not correlate with estimated right ventricular systolic pressure, outflow tract gradient or degree of pulmonary incompetence or right ventricular dilation. On exercise, 5 (19%) of 26 patients had ventricular premature complexes at low levels of exercise that were suppressed at maximal exercise in all patients. CONCLUSIONS: Late ventricular arrhythmia is rare in patients with successful early correction of tetralogy of Fallot, unless complex or multiple operations are performed.
AIM: To describe the relief of symptoms and improvement in Quality of Life (QoL) 5 years after coronary artery bypass grafting (CABG) in relation to preoperative ejection fraction (EF). METHODS: Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Quality of Life was estimated with three different instruments: Physical activity score, Nottingham Health Profile and Psychological General Well-being Index. RESULTS: Among all patients who underwent CABG (n = 1904) the 5-year mortality rate was 27% in those with EF < 0.40 and 12% in those with EF > or = 0.40 (p < 0.0001). In all, 849 patients, of whom 58 (7%) had EF < 0.40 participated in the evaluation. Neither physical activity, symptoms of chest pain, dyspnea nor any indices of QoL were significantly associated with preoperative EF. Improvement in physical activity, symptoms of chest pain and dyspnea and various estimates of QoL appeared similar and marked regardless of preoperative EF. CONCLUSION: Among survivors there was no association between preoperative EF and symptoms or various estimates of QoL 5 years after CABG. Improvement in symptoms and QoL were not dependent on preoperative EF.
Coronary- and LV-angiography in coronary heart disease are indicated I) to clarify whether or not surgery is required (e.g. aorto-coronary-bypass operation, aneurysmectomy) in 1) drug resistent angina pectoris, 2) myocardial aneurysms (or the suspicion of), 3) VSD following myocardial infarction and/or 4) as preoperative investigations in mitral regurgitation or 5) other valve lesions. II) These investigations are furthermore indicated in the under-50-yr.-old considering their prognosis and diagnosis 1) following myocardial infarction 2) to clarify a pathological exercise test with or without angina pectoris 3) in the differential diagnosis of myocardial diseases and 4) occasionally in patients with a number of risk factors or exposed to particular occupational hazards or from families with a high incidence of early deaths from heart disease. Coronary- and LV-angiography are contraindicated in 1) generalized stenosing atherosclerosis, 2) acute myocardial infarction, 3) failure from other organ-systems (e.g. kidney), 4) drug resistent endogenous risk factors and/or relevant obesity, 5) biological age over 60-65.6) continued nicotine dependence. In many cases the specific diagnostic investigations will include the assessment of coronary flow at rest and during maximal drug induced coronary dilatation. This enables us to estimate the coronary reserve and to diagnose coronary insufficiency in patients with normal coronary angiograms.- Instructive morphological and/or functional results illustrate this presentation.
The clinician must first understand the natural history of chronic lower extremity ischemia before making a decision regarding therapeutic options. Clearly, mild ischemia as evidenced by claudication does not place the patient at significant risk for limb loss. Initial conservative treatment emphasizing abstinence from tobacco products, control of underlying medical maladies, and an exercise program, along with patient reassurance, will adequately treat the majority of claudicators. When ischemia is present, patient education regarding foot care and avoidance of trauma are beneficial. Limb-threatening ischemia often requires revascularization. Adequate preoperative cardiologic evaluation and intraoperative monitoring have greatly reduced the morbidity and mortality of arterial reconstruction. Selection of the appropriate recipient vessel and bypass conduit enables limb salvage, whereas amputation would have been performed just a few years ago. Continued analysis of treatment outcomes will further define appropriate intervention in the future.
Nine patients were clinically diagnosed as having a pronator syndrome, i.e., high median nerve compression. The main symptom was pain at the proximal volar aspect of the forearm increasing for several hours after exercise. All patients showed local tenderness over the median nerve 4-5 cm distal to the elbow and pain on active forearm pronation against resistance. Two patients had been previously operated upon for carpal tunnel syndrome. Preoperative routine neurographic-electromyographic studies were normal. In the differential diagnosis, the exclusion of carpal tunnel syndrome and anterior interosseous nerve entrapment is most important. On active isometric forearm pronation, interference with median nerve motor conduction occurred in three patients preoperation. This phenomenon had disappeared following median nerve decompression at the level of the pronator muscle. Fibrous bands from the pronator muscle, encircling the nerve, seemed to be an etiological factor. Eight of nine patients were either improved or recovered completely by surgical treatment.
Since February 1969 carotid sinus nerve stimulators have been implanted in 13 patients with intractable, incapacitating angina pectoris, unrelieved by medical management and, in some cases, revascularization procedures. Four patients died, one on the third postoperative day, the others at 15, 31 and 49 months postoperatively. Two other patients sustained myocardial infarcts, at two weeks and two months postoperatively. Complications were few and transient. The condition of two patients is now deteriorating.In all cases there was relief of pain and a decrease in blood pressure and heart rate. Exercise could be performed at a heavier load or for a longer time. Use of the stimulator was both intermittent and continuous, proving especially valuable in the relief of nocturnal angina. All patients were markedly improved and able to leave hospital.Four patients underwent aortocoronary bypass 14, 15, 22 and 28 months after implantation of the device; three obtained good results and no longer require the CSNS although it remains in place. The fourth obtained little improvement and continues to use the stimulator.
Explore the source record for details and available documents.
Successful treatment of acute fractures of the proximal humerus with prosthetic replacement is a therapeutic challenge to the orthopaedic surgeon, and requires proper elevation of the patient, proper surgical technique, and meticulous rehabilitation. Fractures that require prosthetic replacement as the definitive treatment include 4-part fractures and fracture dislocations, head-split fractures with > 40% articular surface involvement, and selected 3-part fractures. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture evaluation. Factors important for a successful outcome include gentle soft tissue technique, secure placement of the prosthesis with proper version and height, secure tuberosity reconstruction, meticulous rotator cuff repair, and a motivated patient who is able to understand and perform the rigorous postoperative rehabilitation. Postoperative rehabilitation must be individualized in each case, and the treatment plans should be carefully outlined by the operating surgeon at the completion of the surgical reconstruction. Of 70 cases treated with prosthetic replacement, results were excellent in 31, satisfactory in 22, and unsatisfactory in 17. Unsatisfactory results were associated with tuberosity detachment, prosthetic loosening, inadequate or noncompliant rehabilitation, preoperative nerve injury, humeral malposition, dislocation, deep infection, and ectopic bone formation.