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Sample records for syncope patients results

  1. Frequency of Syncope in Patients with Accessory Atrioventricular Connection

    Directory of Open Access Journals (Sweden)

    A Aslani

    2010-03-01

    Full Text Available Background: Syncope in patients with Wolff-Parkinson-White (WPW syndrome is related to rapid reciprocating tachycardia or rapid ventricular response over the accessory pathway during atrial fibrillation (AF. The aim of this retrospective study is to evaluate the frequency of syncope in patients with WPW syndrome. Methods: We reviewed the records of 150 consecutive patients with WPW syndrome.Results: There were 20 patients (13.3% who reported at least one episode of syncope and 130 patients (86.7% without such a history.Conclusion: Syncope is relatively frequent in patients with WPW. Patient with WPW syndrome who has experienced this symptom should be thoroughly evaluated.

  2. Prevalence of family history in patients with reflex syncope

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Benn, Marianne; Kaijer, Michelle Nymann

    2013-01-01

    Reflex syncope is defined by a rapid transient loss of consciousness caused by global cerebral hypoperfusion resulting from vasodilatation and/or bradycardia attributable to inappropriate cardiovascular reflexes. A hereditary component has been suggested, but prevalence of family history may differ...... among subtypes of reflex syncope, as these have different autonomic responses and pathogeneses may be diverse. The present study aimed to assess the prevalence of a positive family history of syncope and cardiovascular characteristics in patients with cardioinhibitory and vasodepressor reflex syncope....... Patients (n=74) were classified into subtypes of reflex syncope - cardioinhibition/asystole (Vasovagal Syncope International Study subtypes II-B [VASIS II-B], n=38) or vasodepressor (VASIS III, n=36) - using the head-up tilt test. Family history was obtained by questionnaires supplemented by interview...

  3. Syncope

    Science.gov (United States)

    ... unconscious for a minute or two, but will revive and slowly return to normal. Syncope can occur ... unconscious for a minute or two, but will revive and slowly return to normal. Syncope can occur ...

  4. [Therapeutic approach to patients with neurocardiogenic syncope].

    Science.gov (United States)

    Zyśko, Dorota; Gajek, Jacek; Halawa, Bogumił

    2004-11-01

    Vasovagal syncopes are the most common cause of loss of consciousness and if they occur frequently they contribute to the marked decrease of the quality of life and need treatment. One of important problems is the possibility of injury during the syncope. In older patients it can lead to the fractures of extremities, complications of which could be life-threatening. Another problem is the reaction of the surrounding people trying to help the unconscious by keeping him in the vertical position. It promotes hypotonia and could cause damage of organs such as brain or heart. The authors review the current literature on the management of patients with vasovagal syncope. It seems that the conservative approaches preferring patient reassurance and training methods are successful in syncope prevention and help avoid the side effects and complications of pharmacological therapy or pacemaker implantation. These last two methods should be reserved for patients with the most severe symptoms of the disease.

  5. Initial Evaluation of Patients with Presumed Syncope

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    Ilknur Can, MD

    2008-01-01

    Full Text Available Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC. The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute care facility, is challenging since patients are usually asymptomatic when they come for medical attention, may have little or no recall of the event, and witnesses, if any, often cannot provide reliable information. Given these circumstances, it is understandable that frontline physicians often tend to take a seemingly ‘safe’ approach, and admit both high-risk and intermediate-risk syncope patients to hospital. This strategy has many implications, including life-style and economic concerns for the patient, and health care management issues for physicians, hospital administrators and the overall health care system. The European Society of Cardiology (ESC. guidelines and several clinical studies provide helpful advice regarding “risk stratification” to help guide physicians in selecting patients for either early hospital admission or later oupatient subspeciality evaluation. The utility of syncope management units in the ED, and a guideline-based approach to the syncope patient, has tended to both diminish the number of undiagnosed cases and reduce the hospital admission rate. In this review, we have attempted to both highlight a cost-effective diagnostic pathway beginning with the initial evaluation of the patient with suspected syncope, and to provide criteria which may help frontline physicians better base their decisions regarding need for in-hospital versus outpatient clinic evaluation of syncope patients.

  6. Pacemaker Therapy in Patients With Neurally Mediated Syncope and Documented Asystole Third International Study on Syncope of Uncertain Etiology (ISSUE-3) A Randomized Trial

    NARCIS (Netherlands)

    Brignole, Michele; Menozzi, Carlo; Moya, Angel; Andresen, Dietrich; Blanc, Jean Jacques; Krahn, Andrew D.; Wieling, Wouter; Beiras, Xulio; Deharo, Jean Claude; Russo, Vitantonio; Tomaino, Marco; Sutton, Richard; Tomaino, M.; Pescoller, F.; Donateo, P.; Oddone, D.; Russo, V.; Pierri, F.; Matino, M. G.; Vitale, E.; Massa, R.; Piccinni, G.; Melissano, D.; Menozzi, C.; Lolli, G.; Gulizia, M.; Francese, M.; Iorfida, M.; Golzio, P.; Gaggioli, G.; Laffi, M.; Rabjoli, F.; Cecchinato, C.; Ungar, A.; Rafanelli, M.; Chisciotti, V.; Morrione, A.; del Rosso, A.; Guernaccia, V.; Palella, M.; D'Agostino, C.; Campana, A.; Brigante, M.; Miracapillo, G.; Addonisio, L.; Proclemer, A.; Facchin, D.; Vado, A.; Knops, R. E.; Dekker, L. R. C.

    2012-01-01

    Background-The efficacy of cardiac pacing for prevention of syncopal recurrences in patients with neurally mediated syncope is controversial. We wanted to determine whether pacing therapy reduces syncopal recurrences in patients with severe asystolic neurally mediated syncope. Methods and

  7. Driving safety among patients with neurocardiogenic (vasovagal) syncope.

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    Bhatia, A; Dhala, A; Blanck, Z; Deshpande, S; Akhtar, M; Sra, A J

    1999-11-01

    Neurocardiogenic syncope is one of the most common causes of syncope. However, the important issue of driving related injury due to syncope in this population is not well defined. Risk of injury due to syncope while driving and driving behavior was evaluated in 155 consecutive patients (92 women and 63 men; mean age 49 +/- 19 years) with history of syncope in whom hypotension and syncope or presyncope could be provoked during head-up tilt testing. Patients with syncope and positive head-up tilt table test were treated with pharmacological therapy. All participants were asked to fill out a detailed questionnaire regarding any driving related injuries and their driving behavior before tilt table testing and during follow-up. Prior to head-up tilt testing two patients had syncope while driving, and one of these patients had syncope related injury during driving. The mean duration of syncopal episodes was 50 +/- 14 months (range 12-72 months). Of the 155 patients, 52 (34%) had no warning prior to syncope, while 103 (6%) had warning symptoms such as dizziness prior to their clinical syncope. Following a diagnosis of neurocardiogenic syncope established by head-up tilt testing, six patients stopped driving on their own. During a median follow-up of 22 months recurrent syncope occurred in five (3.2%) patients. No patient had syncope or injury during driving. In conclusion, syncope and injury while driving in patients with neurocardiogenic syncope is rare. The precise mechanism of this is unclear but may be related to posture during driving. Consensus among the medical community will be needed to provide specific guidelines in these patients.

  8. Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

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    Ranya A Hegazy

    2008-02-01

    Full Text Available Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16 years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65 and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3% while 10.7% (n=25 had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2% were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope.

  9. Efficacy of tilt training in patients with vasovagal syncope.

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    Gajek, Jacek; Zyśko, Dorota; Mazurek, Walentyna

    2006-06-01

    . During the follow-up period, in 5 patients from the study group the diagnosis of VVS was not confirmed and another condition was diagnosed. In the control group, syncope recurrences occurred in 13 (44.5%) patients (p <0.05 vs study group). In patients with VVS, tilt training is effective in the majority of patients. Syncopal or presyncopal episodes and positive results of tilt testing take place more frequently in the early rather than in the late phase of training. Cessation of tilt training causes a recurrence of positive results of tilt testing in spite of the lack of spontaneous syncopal episodes. During long-term observation, a proper diagnosis, different from VVS, can be established in some patients.

  10. Current investigation and management of patients with syncope

    DEFF Research Database (Denmark)

    Dagres, Nikolaos; Bongiorni, Maria Grazia; Dobreanu, Dan

    2013-01-01

    and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were...... almost uniformely reported as the standard treatment for neurally mediated syncope....

  11. Role of head-up tilt table testing in patients with syncope or transient loss of consciousness

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    Toshiyuki Furukawa, MD, PhD

    2017-12-01

    Full Text Available The tilt table test (TTT is a useful method for the management of reflex syncope. However, the TTT is incomplete and has several problems. The indications for this test are established using guidelines. The TTT is not suitable for all syncopal patients. It is currently unclear (1 When should the TTT be used, (2 for which types of patients TTT should be performed, and (3 does the TTT provide useful information to guide indication for pacing therapy for reflex syncope. The answers to these questions appear in recent reports from two guidelines published by the European Society of Cardiology and the Japan Circulation Society. The indications for TTT do not apply to all syncopal patients, but selected patients. For patients with low risks and rare syncopal events, the TTT is not necessary, even when diagnoses are unconfirmed. The TTT is used not only for diagnosis of reflex syncope, but also for many clinical management of several conditions (i.e., exclusion of cardiac syncope. Positive TTT results cannot predict the effects of pacing therapy for reflex syncope. The decision to use pacing therapy should be based on documented electrocardiograms and other findings, including TTT results. Keywords: Tilt table testing, Reflex syncope, Pacemaker, Italian protocol, Management of syncope

  12. Syncope cluster in a patient with vasovagal history.

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    Zyśko, Dorota; Sokalski, Leszek; Gajek, Jacek; Loboz-Grudzień, Krystyna

    2010-10-01

    We report a case of a 55 year-old man with a history of vasovagal syncope who experienced six unexpected syncopal events over the course of two hours. Two of these occurred in the supine position during ECG monitoring, which showed a long-lasting sinus pause. Before the last syncopal episode, the ECG recording was started at the moment when the patient had the recurrence of presyncopal symptoms. Recordings showed sinus rhythm slowing for 12 s and then sinus arrest lasting for 29 s. A thorough clinical examination revealed no relevant abnormalities. The patient was treated with a permanent pacemaker implantation.

  13. Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

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    Rafanelli M

    2014-02-01

    Full Text Available Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT, carotid sinus massage (CSM, or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was

  14. Brain Computed Tomography evaluation of patients with syncopal ...

    African Journals Online (AJOL)

    Objective: The aim of our study is to determine the value of using brain computerized tomography as a routine investigation in patients presenting with syncope to the emergency department at King Hussein Medical Center Amman Jordon. Methods: In the time period between March 2006 and April 2008, a total of 254 ...

  15. Sympatho-vagal responses in patients with sleep and typical vasovagal syncope

    NARCIS (Netherlands)

    Jardine, D. L.; Krediet, C. T. P.; Cortelli, P.; Frampton, C. M.; Wieling, W.

    2009-01-01

    Sleep syncope is a recently described form of vasovagal syncope that interrupts sleep. The pathophysiology of this condition is uncertain but a 'central' non-baroreflex-mediated trigger has been suggested. In the present study, we tested the hypothesis that patients with sleep syncope have abnormal

  16. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope.

    Science.gov (United States)

    Christ, Michael; Geier, Felicitas; Popp, Steffen; Singler, Katrin; Smolarsky, Alexander; Bertsch, Thomas; Müller, Christian; Greve, Yvonne

    2015-02-01

    We examined the diagnostic and predictive value of high-sensitivity cardiac troponin T (cTnThs) in patients with syncope. We performed an analysis of consecutive patients with syncope presenting to the emergency department. The primary end point was the accuracy to diagnose a cardiac syncope. In addition, the study explored the prognostic relevance of cTnThs in patients with cardiac and noncardiac syncope. A total of 360 patients were enrolled (median age, 70.5 years; male, 55.8%; 23.9% aged >80 years). Cardiac syncope was present in 22% of patients, reflex syncope was present in 40% of patients, syncope due to orthostatic hypotension was present in 20% of patients, and unexplained syncope was present in 17.5% of patients. A total of 148 patients (41%) had cTnThs levels above the 99% confidence interval (CI) (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the area under the curve (0.77; CI, 0.72-0.83; P value of cTnThs levels within 30 days: Patients with increased cTnThs levels had a 52% likelihood for adverse events, patients with cTnThs levels below the cutoff point had a low risk (negative predictive value, 83.5%). Increased cTnThs levels indicate adverse prognosis in patients with noncardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself. Patients with syncope presenting to the emergency department have a high proportion of life-threatening conditions. cTnThs levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Syncope paradox in the outcome of patients with pulmonary thromboembolism: short-term and midterm outcome.

    Science.gov (United States)

    Seyyedi, Seyyed-reza; Jenab, Yaser; Tokaldany, Masoumeh Lotfi; Shirani, Shapoor; Sadeghian, Saeed; Jalali, Arash

    2016-01-01

    We compare the early and midterm outcomes of pulmonary thromboembolism (PTE) in patients with and without syncope in our single-center registry. Between December 2006 and May 2013, 351 consecutive patients (mean age = 60.21 ± 16.91 years, 55.3% male) with confirmed acute symptomatic PTE were divided in with and without syncope groups. Groups were compared in terms of the effect of syncope on 30-day mortality and adverse events, and mortality in a median follow-up time of 16.9 months. From 351 patients, 39 (11.1%) had syncope and 312 (88.9%) did not. Syncope group had less frequently chest pain (30.8% vs 51.4%; P value = 0.015). Also, the rates of 30-day adverse events and mortality were 12.8% and 5.1% for the group with syncope, and 14.4% and 10.3% for the group without syncope, respectively, with no significant difference. At follow up, 65 patients died and mortality was 18.5% for 351 patients (5.1% in the group with syncope and 20.2% for the other group). After adjustment for confounding factors, the effect of syncope on 30-day adverse events and mortality remained non-significant and on the midterm mortality was significant, showing that the presence of syncope was associated with lower midterm mortality (P value = 0.038). Among PTE patients in our registry, 11.1% presented with syncope. Relationship between syncope and 30-day adverse events and mortality remained non-significant after adjustments for other factors. However, in midterm follow up, patients with syncope were significantly at decreased risk of mortality compared to those without syncope. © 2014 John Wiley & Sons Ltd.

  18. Syncope Associated with Subthalamic Nucleus Deep Brain Stimulation in a Patient with Parkinson’s Disease

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    Dursun Aygun

    2013-01-01

    Full Text Available In advanced Parkinson's disease (PD, deep brain stimulation (DBS may be an alternative option for the treatment of motor symptoms. Side effects associated with subthalamic nucleus (STN DBS in patients with PD are emerging as the most frequent sensory and motor symptoms. DBS-related syncope is reported as extremely rare. We wanted to discuss the mechanisms of syncope associated with STN DBS in a patient with Parkinson's disease. Case report. Sixty-three-year-old female patient is followed up with diagnosis of idiopathic Parkinson's disease for 6 years in our clinic. The patient has undergone STN DBS due to painful dystonia and drug resistant tremor. During the operation, when the left STN was stimulated at 5 milliampere (mAmp, the patient developed presyncopal symptoms. However, when the stimulation was stopped symptoms improved. During the early period after the operation, when the right STN was stimulated at 1.3 millivolts (mV, she developed the pre-yncopal symptoms and then syncope. Our case shows that STN DBS may lead to directly autonomic symptoms resulting in syncope during stimulation-on (stim-on.

  19. A hairy fall: syncope resulting from topical application of minoxidil.

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    Dubrey, S W; VanGriethuysen, J; Edwards, C M B

    2015-09-07

    We describe the case of a young man who developed syncope after using a high strength formulation of topical minoxidil as a hair growth restorer. Other potential cardiovascular and endocrine causes were excluded, and his symptoms resolved on discontinuation of the product. While syncope is a recognised side effect of using this powerful systemic antihypertensive agent, few cases are documented in the literature, which we illustrate in our discussion. 2015 BMJ Publishing Group Ltd.

  20. How well are European Society of Cardiology (ESC) guidelines adhered to in patients with syncope?

    LENUS (Irish Health Repository)

    O'Dwyer, C

    2010-01-01

    The ESC guidelines on syncope were published in 2001 and updated in 2004. Adherence to the recommendations enables early stratification of low and high risk patients and prevents unnecessary investigations and admissions. Vasovagal syncope (VVS) is the commonest cause of syncope in all age groups and a low risk condition. The study objective was to determine whether the ESC guidelines were adhered to prior to referral to a syncope unit; 100 consecutive patients with unexplained syncope (52 +\\/- 23 (15-91) years); 53 female. Sixty-six patients had VVS. Forty nine (75%) of patients with VVS had undergone unnecessary investigations prior to diagnosis and 31 (47%) were admitted to hospital for investigation. Research from other countries confirms that adherence to the ESC guidelines expediates accurate diagnosis, improves resource utilization and reduces health care cost. Greater awareness amongst Irish practitioners of guidelines may improve syncope management and reduce costs.

  1. Estimating the Cost of Care for Emergency Department Syncope Patients: Comparison of Three Models

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    Marc A. Probst

    2017-02-01

    Full Text Available Introduction: We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management. Methods: We collected complete health services data, including disposition, testing, and length of stay (LOS, on 67 adult patients (age 60 years and older who presented to the emergency department (ED with syncope at a single hospital. Patients were excluded if a serious medical condition was identified. We created three hospital cost-estimation models to estimate facility costs: V1, unadjusted Medicare payments for observation and/or hospital admission; V2: modified Medicare payment, prorated by LOS in calendar days; and V3: modified Medicare payment, prorated by LOS in hours. Total hospital costs included unadjusted Medicare payments for diagnostic testing and estimated facility costs. We plotted these estimates against actual cost data from the hospital finance department, and performed correlation and regression analyses. Results: Of the three models, V3 consistently outperformed the others with regard to correlation and goodness of fit. The Pearson correlation coefficient for V3 was 0.88 (95% confidence interval [CI] 0.81, 0.92 with an R-square value of 0.77 and a linear regression coefficient of 0.87 (95% CI 0.76, 0.99. Conclusion: Using basic health services data, it is possible to accurately estimate hospital costs for older adults undergoing a hospital-based evaluation for unexplained syncope. This methodology could help assess the potential economic impact of implementing novel clinical algorithms for ED syncope. [West J Emerg Med. 2017;18(2253-257.

  2. Is pacemaker therapy the right key to patients with vasovagal syncope?

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    Radovanović, Nikola N; Kirćanski, Bratislav; Raspopović, Srdjan; Pavlović, Siniša U; Jovanović, Velibor; Milašinović, Goran

    2016-01-01

    Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial. This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation. A retrospective study included 30 patients with pacemaker implanted due to vasovagal syncope in the Pacemaker Center, Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt test was performed to diagnose vasovagal syncope. Patients with cardioinhibitory and mixed type of disease were enrolled in the study. Mean age was 48.1 ± 11.1 years and 18 (60%) patients were men. Mean follow-up period was 5.9 ± 3.0 years. Primarily, implantable loop recorder was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic regression analysis we showed that syncope is statistically more likely to occur after pacemaker implantation in patients with mixed type of vasovagal syncope (p = 0.018). There were two (6.7%) perioperative surgical complications. Pacemaker therapy is a safe treatment for patients with vasovagal syncope, whose efficacy can be improved by strict selection of patients. We showed that symptoms occur statistically more often in patients with mixed type of disease after pacemaker implantation.

  3. Prevalence and clinical outcomes of patients with multiple potential causes of syncope

    NARCIS (Netherlands)

    Chen, Lin Y.; Gersh, Bernard J.; Hodge, David O.; Wieling, Wouter; Hammill, Stephen C.; Shen, Win-Kuang

    2003-01-01

    Objective: To determine the prevalence, predictors, and prognosis of patients with multiple potential causes of syncope. Patients and Methods: This is a retrospective cohort study with prospective follow-up of consecutive patients with syncope of uncertain cause who were referred to the

  4. International Study on Syncope of Uncertain Etiology 2: the management of patients with suspected or certain neurally mediated syncope after the initial evaluation Rationale and study design

    NARCIS (Netherlands)

    Brignole, M.; Sutton, R.; Menozzi, C.; Moya, A.; Garcia-Civera, R.; Benditt, D.; Vardas, P.; Wieling, W.; Andresen, D.; Migliorini, R.; Hollinworth, D.

    2003-01-01

    Study design Multi-centre, prospective observational study Objectives Main objective is to verify the value of implantable loop recorder (ILR) in assessing the mechanism of syncope and the efficacy of the ILR-guided therapy after syncope recurrence. Inclusion criteria Patients who met the following

  5. Laughter-induced syncope.

    Science.gov (United States)

    Kim, Alexander J; Frishman, William H

    2012-01-01

    Reported cases of syncope caused directly by laughter are rare. The common scenario described in a few reports involved episodes of fortuitous laughter, sometimes followed by a short prodrome of lightheadedness, facial flushing, and dizziness, followed by an episode of definite syncope. There were no seizure-like movements, automatisms, or bladder or bowel incontinence. After the syncopal episodes that were seconds in length, the patients regained consciousness, and at that point were fully oriented. These episodes could recur in a similar situation with such laughter. Many of these patients subsequently underwent full syncope workups, without elucidating a primary cardiac or neurologic cause. In this review of laughter-induced syncope, we describe a patient of ours who fit these descriptions. This phenomenon is likely a subtype of benign Valsalva-related syncope, with autonomic reflex arcs coming into play that ultimately result in global cerebral hypoperfusion. Besides the Valsalva produced by a great fit of laughter, laughter itself has its own neuroendocrine and vasculature effects that may play a role.

  6. [Controversies in the conduction and evaluation of clinical trials results for the treatment in vasovagal syncope].

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    Gajek, Jacek; Zyśko, Dorota; Halawa, Bogumił

    2003-05-01

    The vasovagal syncope is a reflex reaction to various stimuli leading to the marked hypotension with or without bradycardia with loss of consciousness and fall of postural muscle tone. The vast majority of the patients recover spontaneously but if the syncope occurs frequently and causes injury of the patients body it worsens the quality of life and needs appropriate treatment. The injuries requiring hospitalization occur approximately in 10% of the patients with vasovagal syncope. The aim of the therapy of affected patients is to diminish the syncope prevalence, to brake the neurocardiogenic reaction on an early stage or to prolong the duration of the presyncope phase to enable the patient prevention of the injury. The lack of clear diagnostic criteria and difficulties with estimation the efficacy of any particular therapeutic intervention in many clinical studies of different authors, inclusion to the studies patients with different clinical presentation stages of the disease contribute to different conclusions, which automatic use in the clinical practice is inappropriate. There is an urgent need to clear the methodological discrepancies and to conduct good planed, large, randomized, multicentre studies to assess the efficacy of different therapeutic methods in the treatment of vasovagal syncope.

  7. Reflex syncope: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Richard Sutton

    2017-12-01

    Full Text Available For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED, the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years, tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient. Keywords: Cardiac pacing, Catheter ablation, Diagnosis, Drugs, Management, Reflex syncope

  8. [Adrenomedullin--the link between the sympathetic nervous system activation and peripheral vasodilatation in some patients with vasovagal syncope].

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota; Halawa, Bogumił

    2004-09-01

    Adrenomedullin (ADM) is a potent vasodilator playing role in regulation of central hemodynamic. The concentration of plasma ADM in healthy people increases under the influence of orthostatic stress. In patients with vasovagal syncope (VS) the changes in ADM concentration could be responsible either for syncope provocation or prevention. The aim of the study was to assess the influence of phase of the head-up tilt test (HUTT) in which the syncope occurred on the plasma concentration of ADM. The study was performed in 25 patients (pts) (18 women and 7 men), mean age 45.0+/-16.1 years with cardiodepressive reactions during HUTT according to the Italian protocol with nitroglycerine (NTG) provocation if necessary: Syncope was caused in 23 pts due to vasovagal reaction: in 17 pts syncope occurred after NTG provocation (group 1), and in 6 pts occurred in the passive phase of tilt (group 2a), in 2 pts due to dysautonomic reactions (group 2b). The head-up tilt test was performed according to ESC guidelines. The blood for ADM concentration was drawn after 30 min supine rest (ADM 1) and immediately after syncope (ADM 2). ADM level was measured using radioimmunological method. The results. In group 1 plasma level of ADM significantly decreased after the HUTT (3.2+/-3.4 vs 1.7+/-1,4 pg/0.1 ml; p<0.05) and in group 2a increased significantly (1.3+/-0.8 vs 2.7+/-1.3 pg/0.1 ml; p<0.05) comparing to baseline values. The ADM concentration did not differ between the groups in baseline conditions and was significantly higher after the syncope in group 2a (p<0.05). Conclusions. The excessive increase of ADM concentration during the passive phase of HUTT could play the causative role in pathogenesis of VS occurring early during the HUTT. In patients with VS after NTG provocation the decrease of ADM concentration can be the result of hemodynamic changes in the presence of vasodilating drug and may be the mechanism that could prevent the syncope.

  9. Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Leonardo Marques; Dutra, João Pedro Passos [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); Mantovani, Augusto [UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Lima, Gustavo Glotz de [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Leiria, Tiago Luiz Luz, E-mail: drleiria@cardiol.br [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil)

    2013-12-15

    Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

  10. Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

    International Nuclear Information System (INIS)

    Fischer, Leonardo Marques; Dutra, João Pedro Passos; Mantovani, Augusto; Lima, Gustavo Glotz de; Leiria, Tiago Luiz Luz

    2013-01-01

    Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature

  11. Tilt-table testing of patients with pacemaker and recurrent syncope

    DEFF Research Database (Denmark)

    Nielsen, Christian E. Haarmark; Kanters, Jørgen K; Mehlsen, Jesper

    2016-01-01

    responses accounting for 72% of patients with a positive test. There were no differences between groups with positive or negative test result regarding age, gender, resting blood pressure and heart rate, daily fluid intake, pacing mode, pacing indication or pacing rhythm at rest. HUT in patients...... protocol with nitroglycerine provocation was used and the test results were classified according to current guidelines. Baseline data were retrieved from the medical records. Overall, 54% of patients had a positive response to HUT. Vasodepressor or orthostatic hypotensive response were the most prevalent...... with pacemakers has a high diagnostic yield. Although, the majority of patients had a vasodepressor or orthostatic hypotensive response, cardioinhibitory response leading to syncope was also seen....

  12. Influence of tilt training on activation of the autonomic nervous system in patients with vasovagal syncope.

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota; Halawa, Bogumił; Mazurek, Walentyna

    2006-04-01

    Tilt training is a new treatment for vasovagal syncope. Its therapeutic efficacy is thought to be the result of the desensitization of cardiopulmonary receptors, but it could be the influence of the tilt training on the activation of the autonomic nervous system as well. The study group consisted of 24 vasovagal patients (17 women and 7 men) aged 32.5 +/- 11.8 years. The diagnostic head-up tilt test was performed according to the Italian protocol with nitroglycerin if necessary. The monitoring head-up tilt test was performed according to the Westminster protocol without provocation, after 1 to 3 months of tilt training. Holter ECG recordings for HRV parameters (time and frequency domain) were obtained from selected 2-min intervals before, during and after the diagnostic and monitoring tilt test. The diagnostic test was positive in the passive phase in 6 and after provocation in 18 patients. During the training period no syncope occurred. Analysing the HRV parameters we demonstrated the following findings: I. mRR decreases immediately after assumption of a vertical position in both tests (diagnostic and monitoring) but in the diagnostic test its further decrease occurs earlier than in the monitoring test; 2. the absolute power of the HF component is greater in the early phase of tilt after tilt training than in the corresponding period in the diagnostic test. After a longer period of tilt training the activation of the sympathetic nervous system in response to the erect position is diminished.

  13. Epidemiological studies on syncope

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth

    2013-01-01

    of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken...... from smaller studies from different clinical settings with wide differences in patient morbidity. Through the extensive Danish registries we examined the characteristics and prognosis of the patients hospitalized due to syncope in a nationwide study. The aims of the present thesis were to investigate......, prevalence and cardiovascular factors associated with the risk of syncope, 4) the prognosis in healthy individuals discharged after syncope, and 5) the prognosis of patients after syncope and evaluation of the CHADS2 score as a tool for short- and long-term risk prediction. The first studies of the present...

  14. Usefulness of implantable loop recorder in a patient with syncope during bathing

    Directory of Open Access Journals (Sweden)

    Motohiro Nakao, MD

    2013-02-01

    Full Text Available A 27-year-old man presented to our hospital with a 1-year-hisory of repeated syncope, which particularly occurred while bathing or on a hot day. The head-up tilt test did not induce arrhythmia; however, blood pressure decreased by 39 mm Hg without any symptoms. Given that no bradycardia/tachycardia was induced on electrophysiological study and carotid sinus massage, an implantable loop recorder (ILR was implanted. After 2 months, syncope again occurred during bathing at midnight. Sinus arrest and a maximum ventricular pause of 10.2 s were documented using the ILR. After pacemaker implantation, the patient had not experienced syncope for 14 months.

  15. Progressive central hypovolaemia in man--resulting in a vasovagal syncope?

    DEFF Research Database (Denmark)

    Sander-Jensen, K; Mehlsen, J; Secher, N H

    1987-01-01

    Hypotensive functional haemorrhage induced by venous pooling of blood in the legs has been reported to be characterized by a vasovagal reaction. In the present study these observations were extended by determination of the hormonal profile developed during progressive central hypovolaemia...... and an emotionally induced vasovagal syncope. In six subjects venous pooling resulted in normotensive central hypovolaemia, in one subject hypotensive central hypovolaemia was induced, and one subject experienced an emotionally induced vasovagal syncope. During normotensive central hypovolaemia heart rate increased...... from 58 +/- 4 to 76 +/- 4 beats min-1 (P less than 0.05) and cardiac output fell from 6.1 +/- 0.4 to 4.1 +/- 0.2 1 min-1. Pulse pressure and central venous pressure decreased from 64 +/- 4 to 53 +/- 4 mmHg, and from 8 +/- 2 to 3 +/- 2 mmHg, respectively. Adrenaline and noradrenaline increased from 87...

  16. 11. Prevalence of psychiatric symptoms among patients with recurrent vasovagal and unexplained syncope

    Directory of Open Access Journals (Sweden)

    A.W. Al-Johar

    2016-07-01

    Full Text Available Syncope is defined as a transient loss of consciousness and absence of postural tone followed by spontaneous recovery. Neurally mediated syncope (vasovagal and idiopathic unexplained syncope (US are the most common causes of syncope. Syncope is a very limiting disease that, if recurrent, affects the patients’ physical and psychological health. Our objective from this study is to measure the prevalence of psychiatric symptoms among patients with US. All patients (>12 years with vasovagal or US who were evaluated in King Khalid University Hospital were identified. Echocardiography and table tilt test reports were reviewed and patients who had cardiac syncope (due to arrhythmia or structural heart disease were excluded (N = 18. Ninety-four patients were included for further psychiatric assessment. The patients were contacted to fill the Symptoms Checklist-90-Revised (SCL-90-R, which is a self-reporting questionnaire used to evaluate traits of depression, anxiety, somatization disorder and phobia. SCL-90-R scale has been translated to Arabic and validated in previous studies. Of the included cohort, 43 responded to fill the assessment scale, and 51 were excluded due to failure of communication (N = 41 or refusal to participate (N = 10. A control group was recruited with a case: control ratio of 1:3 matching for age, gender, and chronic illnesses.There were 43 patients and 129 control subjects, with predominance of females (67.4% and an average age of 33.8 (SD = 16. There was no difference in average scores of depression (13 vs. 14.53, P = 0.31, anxiety (11.3 vs. 10.4, P = 0.51, or phobia (5.4 vs. 5.2, P = 0.88. However, the syncope group had a higher average score for somatization disorder (18.53 vs. 13.66, P = 0.002. Binary logistic regression model was measured after grouping the cohort into above and below median scores. After adjusting for age, gender, and chronic illnesses, the association between syncope and somatization

  17. Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

    DEFF Research Database (Denmark)

    Brinth, Louise; Latif, Tabassam; Pors, Kirsten

    2014-01-01

    ) positions. A hypersensitive response was defined by current guidelines. Results: In the supine position, heart rate (HR) and systolic blood pressure (SBP) decreased during CSM on the right side by 17.0 +/- 15.2 min-1 and 32.5 +/- 25.5 mmHg, and on the left side by 12.8 +/- 14.3 min-1 and 22.7 +/- 20.7 mm....... Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to the stimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or disease entity but rather an acquired cardiovascular instability due to age-related degeneration......Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflex control - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorly understood. Methods: We studied the hemodynamic response to carotid sinus massage (CSM...

  18. Syncope in pediatric patients: a practical approach to differential diagnosis and management in the emergency department [digest].

    Science.gov (United States)

    Fant, Colleen; Cohen, Ari; Vazquez, Michelle N

    2017-04-22

    Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  19. Defining and classifying syncope

    NARCIS (Netherlands)

    Thijs, Roland D.; Wieling, Wouter; Kaufmann, Horacio; van Dijk, Gert

    2004-01-01

    There is no widely adopted definition or classification of syncope and related disorders. This lack of uniformity harms patient care, research, and medical education. In this article, syncope is defined as a form of transient loss of consciousness (TLOC) due to cerebral hypoperfusion. Differences

  20. Familial predisposition to vasovagal syncope.

    Science.gov (United States)

    Negrusz-Kawecka, Marta; Bańkowski, Tomasz; Tabin, Mateusz; Paprocka, Magdalena; Mercik, Agnieszka; Misztal, Jowita; Nowak, Piotr; Zysko, Dorota; Gajek, Jacek

    2012-06-01

    A handful of studies suggest a familial predisposition to vasovagal syncope (WS) but the scope of information available to date is poor. The aim of our study was to evaluate the prevalence of vasovagal syncope and its familial occurrence in the young. The studied group consisted of 281 women and 111 men, aged 18-32 years. Forty-seven percent of the population had one brother or sister, and the mean number of individuals per family was 4.4 +/- 1.0. The questionnaire consisted of 30 questions regarding syncopal history. Syncope was reported in 32.1% of the patients studied (36.7% in women vs. 20.7% in men; P < 0.05), 29.1% of mothers, 16.8% of fathers, 30.9% of sisters and 14.2% of brothers. Logistic regression analysis revealed that positive history regarding the syncope in the whole group of students was related to the female gender (OR 2.17; CI: 1.28-3.7), the history of a syncope in mother (OR 1.74; CI: 1.09-2.78) and the history of a syncope in father (OR 2.22; CI: 1.28-3.86; P < 0.001). A positive history of syncope in male relatives increases the risk of syncope in men and women, whereas a positive history of syncope in female relatives increases the risk of syncope in women only. Female gender independently of the family history increases the risk of syncope. The genetics of the vasovagal syncope could be polygenic but the mechanisms of a transmission remain unclear to date.

  1. [Clonazepam in therapy of neurogenic syncopal states].

    Science.gov (United States)

    Musaeva, Z A

    2001-01-01

    27 patients with frequent neurogenic syncopes (NS) resistant to conventional therapy were treated with clonazepam. The average age of the patients was 29.8 +/- 11.6 years. There were 1-2 syncopes in a month. Both before and after the treatment an active orthostatic test was performed with ECG registration and following analysis of variability of the cardiac rhythm. Clonazepam was administered in a dose of 2-2.5 mg/day during 8-9 weeks. Clinical improvement in the form of a lack of syncopes was observed in 20 patients (74%); 3 patients (10%) had isolated lipothymic states; 2 patients discontinued the treatment because of side-effects (dizziness). The results of the examination of 23 patients 6 months after clonazepam therapy testified the stability of the therapeutic effect.

  2. Syncope in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Pejčić Ljiljana

    2017-09-01

    Full Text Available In the pediatric age group, most cases of syncope represent benign, neutrally-mediated alterations in vasomotor tone. Due to the global cerebral hypoperfusion, syncope is defined as a transient loss of consciousness followed by spontaneous recovery and/or a state of presyncope, including dizziness, lightheadedness, pallor, diaphoresis and palpitations which may precede the loss of consciousness. These symptoms could be a sign of a life-threatening event in a small subset of patients, even though most causes of syncope in childhood are benign, and life-threatening causes of syncope generally have cardiac etiology. In all these cases, routine evaluation includes history, physical examination and a 12-lead standard electrocardiogram which should be performed. Further investigation is indicated by worrying features which include syncope that occurs without warning, syncope during exercise, history of familial sudden death, and abnormalities on clinical exam or electrocardiography. The fact is that syncope generates great fear of injury or sudden death among parents and doctors, and the main aim of the present paper is to help the physician involved in the care of children to differentiate the life-threatening causes of syncope from the common, more benign neutrally-mediated syncope.

  3. Syncope and Motor Vehicle Crash Risk

    DEFF Research Database (Denmark)

    Numé, Anna-Karin; Gislason, Gunnar; Christiansen, Christine Benn

    2016-01-01

    IMPORTANCE: Syncope may have serious consequences for traffic safety. Current clinical guideline recommendations on driving following syncope are primarily based on expert consensus. OBJECTIVE: To identify whether there is excess risk of motor vehicle crashes among patients with syncope compared...... vehicle crashes throughout the follow-up period. This study suggests that syncope should be considered as one of several factors in a broad assessment of fitness to drive....

  4. [Renin-angiotensin-aldosterone system activity during head-up tilt testing in patients with vasovagal syncope].

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota; Mazurek, Walentyna

    2005-08-01

    The stimulation of renin-angiotensin-aldosterone (RAA) system during tilt table test is caused by sympathetic nervous system activation by orthostatic stress and a serotonin release as well. In healthy individuals increase of plasma renin activity during test with maximal values on the peak of the test was described. The aim of the study was to assess the activation of RAAS in patients with neurally mediated syncope during the tilt table test by means of plasma renin activity and serum aldosterone levels. The study was carried out in 31 patients aged 39.4 +/- 15.0 years (18 women and 13 men) with neurally mediated syncope during tilt test. Plasma renin activity was assessed in the baseline conditions, immediately after the test and 10 minutes after the test using radioenzymatic assay. Aldosterone concentrations were measured radioimmunologically, twice: after 30 minutes supine rest and after the syncope. Plasma renin activity during supine rest was 2.2 +/- 2.4 ng/ml/h, rose after the syncope 2.5-fold to 5.2 +/- 4.5 ng/ml/h (p < 0.001 comparing to baseline) stayed on similar level approximately for the next 10 minutes--4.9 +/- 5.5 ng/ml/h (p = n.s.). In 11 patients (35%) 10 minutes after the test even further increase of PRA was observed. Serum aldosterone level increased significantly immediately after tilt test (90.0 +/- 72.9 vs 178.8 +/- 150.1 pg/ml, p < 0.01). Authors showed, that in patients with NMS plasma renin activity increases and this increase lasts for 10 minutes after the syncope and the concentration of aldosterone increases immediately after tilt test.

  5. [Syncope: electrocardiogram and autonomic function tests].

    Science.gov (United States)

    Uribe, William; Baranchuk, Adrián; Botero, Federico

    2016-12-23

    Syncope represents one of the most frequent reasons for consultation in the emergency department. A proper identification will allow a precise etiologic approach and the optimization of delivery of health resources.
Once knowing the classification of syncope; it is the clinical interrogatory what enables to discriminate which of these patients present with a neurogenic mediated syncope or a cardiac mediated syncope. The use of diagnostic methods such as the tilt test, will clarify what type of neurally mediated syncope predominates in the patient.
The electrocardiogram is the cornerstone in the identification of those patients who had a true episode of self-limited or aborted sudden death as the first manifestation of their syncope, a fact which provides prognostic and therapeutic information that will impact the morbidity and mortality.

  6. Sleep syncope: Important clinical associations with phobia and vagotonia

    NARCIS (Netherlands)

    Busweiler, L.; Jardine, D. L.; Frampton, C. M.; Wieling, W.

    2010-01-01

    Objectives: To compare demographic and clinical data from patients with sleep syncope to those of patients with "classical" vasovagal syncope [VVS] collected over the last 8 years. Design: Retrospective case-controlled study. Setting: Syncope unit. Patients and methods: Fifty-four patients with a

  7. Recurrent laughter-induced syncope.

    Science.gov (United States)

    Gaitatzis, Athanasios; Petzold, Axel

    2012-07-01

    Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing, swallowing, or defecation. A healthy 42-year-old male patient presented to the neurology clinic with a long history of faints triggered by spontaneous laughter, especially after funny jokes. Physical and neurological examination, and electroencephalography and magnetic resonance imaging were unremarkable. There was no evidence to suggest cardiogenic causes, epilepsy, or cataplexy and a diagnosis of laughing syncope was made. Laughter-induced syncope is usually a single event in the majority of cases, but may present as recurrent attacks as in our case. Some cases occur in association with underlying neurological conditions. Prognosis is good in the case of neurally mediated attacks. Laughter may not be recognized by physicians as a cause of syncope, which may lead to unnecessary investigations or misdiagnosis, and affect patients' quality of life.

  8. [Neurohumoral mechanisms for vasovagal syncopes. Part II].

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota

    2003-04-01

    Vasovagal syncope is defined as a reflex loss of consciousness related to reaction to various stimuli as orthostatic stress, pain or emotions connected with loss of muscle postural tone. In the second part of the paper the authors describe the possible role of the particular neurohumoral factors and autonomic nervous system in the development of vasovagal syncope. The studies on the involvement of neurohumoral factors in vasovagal syncope can play a key role in a more precise evaluation of affected patients, long term prophylaxis against syncopal events and may contribute to development of more reliable diagnostic tests.

  9. Regional cerebral perfusion in cardiovascular reflex syncope

    International Nuclear Information System (INIS)

    Toeyry, J.P.; Kuikka, J.T.; Laensimies, E.A.

    1997-01-01

    Little is known about the regional cerebral perfusion in subjects with presyncope or syncope, and the impact that autonomic nervous dysfunction has on it. Seven subjects with cardiovascular vasodepressor reflex syncope were studied. A baseline test was performed with the patients standing in the 70 upright position, while the passive head-up tilt table test with and without isoprenaline infusion was employed for provocation. Regional cerebral perfusion was assessed by means of single-photon emission tomography with technetium-99m labelled V-oxo-1,2-N,N 1 -ethylenedylbis-l-cysteine diethylester (baseline, and during blood pressure decline in the provocation test) and the autonomic nervous function by means of spectral analysis of heart rate variability (baseline, and before blood pressure decline in the provocation test). Every subject showed an abrupt decline in blood pressure in the provocation test (five with presyncope and two with syncope). The systolic and diastolic blood pressures decreased significantly (P<0.001) between the baseline and the provocation study time points (radiopharmaceutical injection and lowest systolic blood pressure). Mean cerebral perfusion as average count densities decreased upon provocation as compared with baseline (190±63 vs 307±90 counts/voxel, respectively, P=0.013). Hypoperfusion was most pronounced in the frontal lobe. These results suggest that cerebral perfusion decreases markedly during presyncope or syncope with systemic blood pressure decline in subjects with cardiovascular vasodepressor syncope. Furthermore, the autonomic nervous function remains unchanged before the systemic blood pressure decline. (orig.). With 3 figs., 2 tabs

  10. Clinically oriented device programming in bradycardia patients: part 2 (atrioventricular blocks and neurally mediated syncope). Proposals from AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

    Science.gov (United States)

    Palmisano, Pietro; Ziacchi, Matteo; Biffi, Mauro; Ricci, Renato P; Landolina, Maurizio; Zoni-Berisso, Massimo; Occhetta, Eraldo; Maglia, Giampiero; Botto, Gianluca; Padeletti, Luigi; Boriani, Giuseppe

    2018-04-01

    : The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients' clinical features. In part 2, criteria for pacemaker choice and programming in atrioventricular blocks and neurally mediate syncope are proposed. The atrioventricular blocks can be paroxysmal or persistent, isolated or associated with sinus node disease. Neurally mediated syncope can be related to carotid sinus syndrome or cardioinhibitory vasovagal syncope. In sinus rhythm, with persistent atrioventricular block, we considered appropriate the activation of mode-switch algorithms, and algorithms for auto-adaptive management of the ventricular pacing output. If the atrioventricular block is paroxysmal, in addition to algorithms mentioned above, algorithms to maximize intrinsic atrioventricular conduction should be activated. When sinus node disease is associated with atrioventricular block, the activation of rate-responsive function in patients with chronotropic incompetence is appropriate. In permanent atrial fibrillation with atrioventricular block, algorithms for auto-adaptive management of the ventricular pacing output should be activated. If the atrioventricular block is persistent, the activation of rate-responsive function is appropriate. In carotid sinus syndrome, adequate rate hysteresis should be programmed. In vasovagal syncope, specialized sensing and pacing algorithms designed for reflex syncope prevention should be activated.

  11. Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

    Science.gov (United States)

    Varosy, Paul D; Chen, Lin Y; Miller, Amy L; Noseworthy, Peter A; Slotwiner, David J; Thiruganasambandamoorthy, Venkatesh

    2017-08-01

    To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Of 3,188 citations reviewed, 10 studies met the inclusion criteria for systematic review, including a total of 676 patients. These included 9 randomized trials and 1 observational study. Of the 10 studies, 4 addressed patients with carotid sinus hypersensitivity, and the remaining 6 addressed vasovagal syncope. Among the 6 open-label (unblinded) studies, we found that pacing was associated with a 70% reduction in recurrent syncope (relative risk [RR]: 0.30; 95% confidence interval [CI]: 0.15-0.60). When the 2 analyzable studies with double-blinded methodology were considered separately, there was no clear benefit (RR: 0.73; 95% CI: 0.25-2.1), but confidence intervals were wide. The strongest evidence was from the randomized, double-blinded ISSUE-3 (Third International Study on Syncope of Uncertain Etiology) trial, which demonstrated a benefit of pacing among patients with recurrent syncope and asystole documented by implantable loop recorder. There are limited data with substantive evidence of outcome ascertainment bias, and only 2 studies with a double-blinded study design have been conducted. The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder. Copyright © 2017 American College of Cardiology Foundation, American Heart Association

  12. [Indices of 24-hour monitoring of arterial blood pressure in patients with neurogenic syncope and patients with chronic constitution- dependent hypotension].

    Science.gov (United States)

    Musaeva, Z A; Khapaev, B A; Fedotova, A V; Oknin, V Iu

    1999-01-01

    Clinical-psychologic study, spectral analysis of heart rate variability, 24-h monitoring of arterial pressure (AP) were performed in 20 patients with chronic constitutional arterial hypotension and in 18 patients with neurogenic syncopal states. Both groups were characterised by considerable manifestations of the syndrome of autonomic dystonia, by emotional-personal disorders that correlated with elevated level of slow-waves of the second order in heart rhythms' spectrum. That testified activation of supersegmental sympathetic-adrenal systems. Disorders in sympathetic-parasympathetic correlations were specific in each group. In patients with arterial hypotension disorder of circadian rhythm was observed in the form of superfluous decrease of diastolic AP during sleep. Circadian rhythms in patients with neurogenic syncopes have parameters characteristic for normals showing a preverved chronobiologic AP regulation. A role of the alterations revealed in pathogenesis of arterial hypotensionis discussed.

  13. Cardiovascular causes of syncope. Identifying and controlling trigger mechanisms

    International Nuclear Information System (INIS)

    Akhtar, M.; Jazayeri, M.; Sra, J.

    1991-01-01

    Syncope usually has a cardiovascular source, so neurologic evaluation has a low diagnostic yield in these patients. Cardiac arrhythmias in persons with or without structural heart disease can produce syncope. Neurocardiogenic dysfunction that results in diminished venous return and hypercontractility is another frequent cause. Postural hypotension or left ventricular outflow obstruction may also be to blame. Careful history taking and physical examination, head-up tilt testing, echocardiography or radionuclide isotope imaging, and electrophysiologic study are often diagnostic. However, syncope remains undiagnosed in some patients, and they may require periodic reassessment. Treatment options are available for most cardiovascular disorders, among them use of pharmacologic agents; catheter, surgical, or radio-frequency modification of certain tachycardias; and permanent pacing. 33 references

  14. Syncope: Evaluation and management | Mohamed | Libyan Journal ...

    African Journals Online (AJOL)

    Syncope is a sudden transient loss of consciousness and postural tone with spontaneous recovery. Loss of consciousness results from a reduction of blood flow to the reticular activating system located in the brain stem. Syncope is an important clinical problem which accounts for 1% of hospital admissions and 3% of ...

  15. Bedside Heart Type Fatty Acid Binding Protein (H-FABP): Is an Early Predictive Marker of Cardiac Syncope

    International Nuclear Information System (INIS)

    Sonmez, B. M.; Yilmaz, F.; Durdu, T.; Hakbilir, O.; Ongar, M.; Ozturk, D.; Altinbilek, E.; Kavalci, C.; Turhan, T.

    2015-01-01

    Objective: To determine the value of bedside heart-type fatty acid binding protein in diagnosis of cardiac syncope in patients presenting with syncope or presyncope. Methods: The prospective study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, between September 1, 2010, and January 1, 2011, and comprised patients aged over 18 years who presented with syncope or presyncope. Patients presenting to emergency department within 4 hours of syncope or presyncope underwent a bedside heart-type fatty acid binding protein test measurement. SPSS 16 was used for statistical analysis, Results: Of the 100 patients evaluated, 22(22 percent) were diagnosed with cardiac syncope. Of them, 13(59.1 percent) patients had a positive and 9(40.9 percent) had a negative heart-type fatty acid binding protein result. Consequently, the test result was 12.64 times more positive in patients with cardiac syncope compared to those without. Conclusions: Bedside heart-type fatty acid binding protein, particularly at early phase of myocardial injury, reduces diagnostic and therapeutic uncertainity of cardiac origin in syncope patients. (author)

  16. Role of echocardiography in the evaluation of syncope: a prospective study

    Science.gov (United States)

    Sarasin, F P; Junod, A-F; Carballo, D; Slama, S; Unger, P-F; Louis-Simonet, M

    2002-01-01

    Objective: To study the role of echocardiography in the stepwise evaluation of syncope. Design: A prospective observational study with an 18 month follow up. Setting: University teaching hospital providing primary and tertiary care. Subjects: 650 consecutive patients with syncope and clinical suspicion of an obstructive valvar lesion, or with syncope not explained by history, physical examination, or a 12 lead ECG, who underwent bidimensional Doppler transthoracic echocardiography. Main outcome measures: The causes of syncope were assigned using published diagnostic criteria. Echocardiography was considered diagnostic when confirming a suspected diagnosis, or when revealing occult cardiac disease explaining the syncope. Results: A systolic murmur was identified in 61 of the 650 patients (9%). Severe aortic stenosis was suspected in 20 of these and was confirmed by echocardiography in eight. Follow up excluded further cases of aortic stenosis. In patients with unexplained syncope (n = 155), routine echocardiography showed no abnormalities that established the cause of the syncope. Echocardiography was normal or non-relevant in all patients with a negative cardiac history and a normal ECG (n = 67). In patients with a positive cardiac history or an abnormal ECG (n = 88), echocardiography showed systolic dysfunction (left ventricular ejection fraction ≤ 40%) in 24 (27%) and minor non-relevant findings in the remaining 64. Arrhythmias were diagnosed in 12 of the 24 patients with systolic dysfunction (50%), and in 12 of the 64 remaining patients (19%) (p < 0.01). Conclusions: Echocardiography was most useful for assessing the severity of the underlying cardiac disease and for risk stratification in patients with unexplained syncope but with a positive cardiac history or an abnormal ECG. PMID:12231593

  17. [Features of daily rhythm of arterial pressure in patients with primary arterial hypertension and neurogenic syncope conditions].

    Science.gov (United States)

    Musaeva, Z A; Oknin, V Iu; Khapaev, B A; Fedotova, A V; Veĭn, A M

    2002-01-01

    A comparative analysis of parameters of systemic BP in patients with primary arterial hypotension (PAH) and in patients with neurogenic syncopes (NS) in the cycle sleep-awake. Blood pressure was investigated in 20 patients with PAH aged 16-44 years and 18 patients with NS aged 16-49 years. 24-h ambulatory monitoring of BP was made on the monitor ABPM-02/M (Meditech, Hungary). Rhythm indices of BP in NS patients corresponded to age normal criteria. 24-h arrhythmia of BP in PAH patients manifests with excessive drop of diastolic BP in sleep (55% patients were overdippers). PAH and NS patients differ maximally by hypotonic load in sleep: 1.0 +/- 0.7% in NS vs 15.4 +/- 3.2% in PAH. Hypotonia episodes in awake PAH patients were registered at each 4th-5th measurement of BP, in NS patients--at each 11th-13th. Heart rate in awake PAH patients is higher than in healthy subjects. Hypotonic load in sleep carries the highest differentially-diagnostic importance. This makes more perspective examinations of such patients in the cycle sleep-awake. The changes observed in PAH patients evidence for activation of cerebral sympathico-adrenal systems participating in baroreflex regulation.

  18. Recurrent Laughter-induced Syncope

    NARCIS (Netherlands)

    Gaitatzis, A.; Petzold, A.F.S.

    2012-01-01

    Introduction: Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing,

  19. Syncope: risk stratification and clinical decision making.

    Science.gov (United States)

    Peeters, Suzanne Y G; Hoek, Amber E; Mollink, Susan M; Huff, J Stephen

    2014-04-01

    Syncope is a common occurrence in the emergency department, accounting for approximately 1% to 3% of presentations. Syncope is best defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. The spectrum of etiologies ranges from benign to life threatening, and a structured approach to evaluating these patients is key to providing care that is thorough, yet cost-effective. This issue reviews the most relevant evidence for managing and risk stratifying the syncope patient, beginning with a focused history, physical examination, electrocardiogram, and tailored diagnostic testing. Several risk stratification decision rules are compared for performance in various scenarios, including how age and associated comorbidities may predict short-term and long-term adverse events. An algorithm for structured, evidence-based care of the syncope patient is included to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely.

  20. The changing face of orthostatic and neurocardiogenic syncope with age.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    AIM: Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages. METHODS: This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines. RESULTS: A total of 3002 patients were included (1451 short tilt, 127 active stand, 1042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1914 females; 1088 males. Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P = 0.03). NCS demonstrated a bimodal age distribution. Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years. Those with vasovagal syncope (n = 80) had a median (IQR) age of 30 (19-44) years. There were 57 patients with isolated postural orthostatic tachycardia syndrome. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years. CONCLUSION: We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.

  1. Epidemiological studies on syncope--a register based approach

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth

    2013-01-01

    of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope, differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken......: 1) the use, validity and accuracy of the ICD-10 diagnosis of syncope R55.9 in the National Patient Registry for the use of this diagnosis in the epidemiology of syncope, 2) diagnostics used and etiology of a random selection of patients who had a discharge diagnosis of R55.9, 3) the incidence...... thesis demonstrated that the ICD-10 discharge diagnosis could reliably identify a cohort of patients admitted for syncope and that the discharge code carried a high number of unexplained cases despite use of numerous tests. The last studies showed that syncope is a common cause for hospital contact...

  2. [Usefulness of a protocol for carotid sinus massage in supine and erect postures in patients with syncope without other cardiovascular or neurological diseases].

    Science.gov (United States)

    Bocchiardo, M; Alciati, M; Buscemi, A; Cravetto, A; Richiardi, E; Gaita, F

    1995-05-01

    Carotid sinus massage is a first level test when investigating the cause of syncope. It is normally performed in the supine and erect positions. However, there is no standard complete protocol. So we have devised a new protocol to evaluate the utility of carotid sinus massage in different postures and the influence of patients age on the response. Two groups of subjects were selected: a group of 167 patients (mean age 50 ys +/- 18, 105 males, 62 females) with a history of syncope without cardiovascular and neurological disease and 20 asymptomatic control subjects (mean age 52 ys +/- 13, 11 males, 9 females). Carotid sinus massage was performed supine, just after passive tilt, after 5 minutes of tilt and just after passive return to supine. If a pause > 3" was detected, the protocol was repeated after atropine i.v. injection. Borderline vasodepressor: blood pressure reduction > 30 but blood pressure reduction > 50 mm Hg or > 30 mm Hg with symptoms like dizziness, vertigo or syncope; cardioinhibitory: pause > 3"; mixed: cardioinhibitory with blood pressure reduction > 30 mm Hg after atropine. Carotid sinus massage gave all informations in the supine position in 14 (12%) patients, after passive tilt in 67 (57%), after 5 minutes of tilt in 30 (26%), and after return to supine in 6 (5%). The responses were: 13 (8%) borderline vasodepressor, 32 (19%) vasodepressor, 2 (1%) cardioinhibitory, 70 (42%) mixed, 50 (30%) negative. Positive responses were more frequent in patients over 45 years (90% versus 43%). In the control group only 3 (15%) positive responses were elicited (2 borderline vasodepressor, and 1 vasodepressor, all in subjects over 45). This protocol for carotid sinus massage evidenced positive responses in 70% of patients with syncope without cardiovascular and neurological disease; cardioinhibitory responses are rare (2%); positive responses are more frequent in patients over 45 years; the protocol specificity was 85%.

  3. Recurrent Syncope Due to Carotid Sinus Hypersensitivity and Sick Sinus Syndrome

    Directory of Open Access Journals (Sweden)

    Feng-Yu Kuo

    2008-10-01

    Full Text Available Syncope is a sudden and brief loss of consciousness with postural tone. Its recovery is usually spontaneous. There are various causes of syncope including cardiac, vascular, neurologic, metabolic and miscellaneous origins. The tracing is usually time-consuming and costly. The diagnosis of carotid sinus syncope may sometimes be difficult since the symptoms are nonspecific, especially in older persons. Here, we report the case of a 72-year-old woman who sought medical attention at our hospital due to repeated syncope episodes over the previous 5 years. Neurologic examinations showed negative results (including brain computed tomography. Twenty-four-hour ambulatory electrocardiogram monitoring showed atrial and ventricular premature contractions only. Electrophysiologic study disclosed prolonged corrected sinus node recovery time (1,737 ms with poor atrioventricular conduction. Drop of blood pressure together with sinus bradycardia developed after left side carotid sinus massage. Both carotid sinus hypersensitivity with sick sinus syndrome contributed to this patient's syncope, and after pacemaker placement together with selective serotonin reuptake inhibitor treatment, she was free from syncope thereafter.

  4. [The usefullness of implantable loop recorders for evaluation of unexplained syncope and palpitations].

    Science.gov (United States)

    Kristjánsdóttir, Ingibjörg; Reimarsdóttir, Guđrun; Arnar, Davíđ O

    2012-09-01

    Syncope is a common complaint and determining the underlying cause can be difficult despite extensive evaluation. The purpose of this study was to evaluate the usefulness of an implantable loop recorder for patients with unexplained syncope and palpitations. This was a retrospective analysis of 18 patients, five of whom still have the device implanted. All patients had undergone extensive evaluation for their symptoms before getting the loop recorder implanted and this was therefore a highly select group. Of the thirteen patients where use of the device was completed, the mean age was 65±20 years. The loop recorder was in use for a mean time of 20±13 months. Unexplained syncope, eleven of thirteen, was the most common indication. The other two received the loop recorder for unexplained palpitations. Four patients had sick sinus syndrome during monitoring, three had supraventricular tachycardia and one had ventricular tachycardia. Further three had typical symptoms but no arrhythmia was recorded and excluding that as a cause. Two patients had no symptoms the entire time they had the loop recorder. Of the five patients still with the device three had syncope as the indication for monitoring and two have the device as a means of evaluating the results of treatment for arrhythmia. This study on our initial experience with implantable loop recorders shows that these devices can be useful in the investigation of the causes of syncope and palpitations.

  5. Syncope management unit: evolution of the concept and practice implementation.

    Science.gov (United States)

    Shen, Win K; Traub, Stephen J; Decker, Wyatt W

    2013-01-01

    Syncope, a clinical syndrome, has many potential causes. The prognosis of a patient experiencing syncope varies from benign outcome to increased risk of mortality or sudden death, determined by the etiology of syncope and the presence of underlying disease. Because a definitive diagnosis often cannot be established immediately, hospital admission is frequently recommended as the "default" approach to ensure patient's safety and an expedited evaluation. Hospital care is costly while no studies have shown that clinical outcomes are improved by the in-patient practice approach. The syncope unit is an evolving practice model based on the hypothesis that a multidisciplinary team of physicians and allied staff with expertise in syncope management, working together and equipped with standard clinical tools could improve clinical outcomes. Preliminary data have demonstrated that a specialized syncope unit can improve diagnosis in a timely manner, reduce hospital admission and decrease the use of unnecessary diagnostic tests. In this review, models of syncope units in the emergency department, hospital and outpatient clinics from different practices in different countries are discussed. Similarities and differences of these syncope units are compared. Outcomes and endpoints from these studies are summarized. Developing a syncope unit with a standardized protocol applicable to most practice settings would be an ultimate goal for clinicians and investigators who have interest, expertise, and commitment to improve care for this large patient population. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Subdural Hematoma Presenting as Recurrent Syncope.

    Science.gov (United States)

    Bruner, David I; Jamros, Christine; Cogar, William

    2015-09-01

    Syncope is a common emergency department (ED) complaint. Recurrent syncope is less common, but may be concerning for serious underlying pathology. It often requires a broad diagnostic evaluation that may include neurologic imaging. We present the case of a 75-year-old man with non-small-cell carcinoma who presented to the ED for recurrent syncope after coughing spells over the 2 weeks preceding his arrival at the ED. He had a normal cardiac evaluation, however, he had some subacute neurologic changes that prompted obtaining a computed tomography (CT) scan of the head. This led to the diagnosis of atraumatic subdural hematoma that was causing transient transtentorial herniation leading to the recurrent syncope. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware that recurrent syncope is a possible presentation of increased intracranial pressure that may be due to a mass lesion, particularly if the patient has any acute or subacute neurologic changes. Although this association with a subdual hematoma is rare, other cases of mass lesions leading to syncope after coughing spells have been reported in the literature. Published by Elsevier Inc.

  7. Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    A. Casini

    2011-09-01

    Full Text Available Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus by metastases of a carcinoma of the esophagus, successfully treated by radiotherapy. In such cases, surgery, chemotherapy or radiotherapy can be performed. Because syncope may be an early sign of neck or cervical cancer, the diagnostic approach of syncope in patients with a past history of cancer should include the possibility of neck tumor recurrence or metastasis and an oncologic workout should be considered.

  8. The influence of a tilt training programme on the renin-angiotensin-aldosterone system activity in patients with vasovagal syncope.

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota; Krzemińska, Sylwia; Mazurek, Walentyna

    2009-08-01

    We assessed the influence of short-term and long-term tilt training on the activity of the renin-angiotensin-aldosterone system (RAAS) in vasovagal patients. Thirty-nine patients (28 F, 11 M) aged 39.7 +/- 11.2 years with a history of vasovagal syncope and a positive head-up tilt test (HUT) were studied. Blood samples for plasma renin activity (PRA) and aldosterone (ALDO) concentration were drawn at the baseline, immediately after HUT and 10 min after HUT, during the diagnostic, the negative short-term (2-5 days) follow-up HUT and long-term (1-3 months) follow-up HUT. Tilt training was started after diagnostic HUT. In diagnostic HUT, PRA increased significantly immediately after HUT comparing to the baseline, during recovery the values did not change. ALDO concentration increased after HUT comparing to baseline and further increased during recovery. After short-term tilt training, PRA and ALDO concentrations did not significantly change compared to their corresponding values in diagnostic HUT. After long-term tilt training, PRA did not significantly change compared to the values in the diagnostic and short-term follow-up HUT. ALDO concentration also did not change significantly at the baseline and immediately after HUT, and 10 min after HUT ALDO concentration was significantly lower than after diagnostic HUT. Tilt training changes the response of RAAS to the prolonged orthostasis in vasovagal patients. The coupling between PRA and ALDO after diagnostic HUT has been found to be altered and the physiological relationship was restored after long-term tilt training. The beneficial effect of tilt training depends partially on changed RAAS activation.

  9. Syncope in children with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    I. V. Leontyeva

    2014-01-01

    Full Text Available Seventy children aged 7 to 17 years with hypertrophic cardiomyopathy (HCM were examined; among them there were 11 syncope patients and 5 presyncope patients. The screening program included standard electrocardiography (ECG, Doppler echocardiogra-phy, 24-hour Holter ECG monitoring, and an incremental exercise testing (Bruce treadmill test. The markers of myocardial electrical instability were determined. In the children with HCM, syncope was established to be heterogeneous; it had an arrhythmogenic origin and, in most cases, occurred in the presence of tachyarrhythmia (44% or bradyarrythmia (25%; its vasovagal genesis was probable in one third of the examinees. The children with syncope were typified by the asymmetric, obstructive form of HCM, at the same tone there was most commonly left ventricular hypertrophy concurrent with left atrial enlargement. 24-hour Holter monitoring showed that bradycardia was prevalent in the patients, 3 patients were found to have more than 2-second cardiac rhythm pauses caused by second-degree atrioventricular block in 1 case or by sick sinus syndrome in 2. Nonsustained ventricular tachycardia was noted in two patients. The children with syncope were typified by the signs of myocardial electrical instability as a reduction in the early phase of heart rate turbulence and by impaired QT/RR interval adaptation as hyperadaptation. The paper presents the developed management tactics for children with syncope and indications for the implantation of a cardioverter defibrillator, a pacemaker, or an ECG loop recorder.

  10. Syncope and Its Impact on Occupational Accidents and Employment

    DEFF Research Database (Denmark)

    Numé, Anna Karin; Kragholm, Kristian; Carlson, Nicolas

    2017-01-01

    Background - First-time syncopal episodes usually occur in adults of working age, but their impact on occupational safety and employment remains unknown. We examined the associations of syncope with occupational accidents and termination of employment. Methods and Results - Through linkage...... of the syncope event. Over a median follow-up of 3.2 years (first to third quartiles, 2.0-4.5), 622 people with syncope had an occupational accident requiring hospitalization (2.1/100 person-years). In multiple Poisson regression analysis, the incidence rate ratio in the employed syncope population was higher......, 2.34-2.91). Conclusions - In this nationwide cohort, syncope was associated with a 1.4-fold higher risk of occupational accidents and a 2-fold higher risk of termination of employment compared with the employed general population....

  11. Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

    DEFF Research Database (Denmark)

    Brinth, Louise Schouborg; Latif, Tabassam; Pors, Kirsten

    2014-01-01

    ) positions. A hypersensitive response was defined by current guidelines. Results: In the supine position, heart rate (HR) and systolic blood pressure (SBP) decreased during CSM on the right side by 17.0 +/- 15.2 min-1 and 32.5 +/- 25.5 mmHg, and on the left side by 12.8 +/- 14.3 min-1 and 22.7 +/- 20.7 mm......Hg, respectively. Changes in SBP were greater in the head-up tilted position (right side; p=0.029, left side; p=0.007). Hypersensitive responses were elicited in 45 patients. We found orthostatic hypotension (OH) (r=-0.275, p=0.015), not CSS, to be inversely correlated to low frequency HR variability during HUT....... Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to the stimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or disease entity but rather an acquired cardiovascular instability due to age-related degeneration...

  12. Simulation of Exercise-Induced Syncope in a Heart Model with Severe Aortic Valve Stenosis

    Directory of Open Access Journals (Sweden)

    Matjaž Sever

    2012-01-01

    Full Text Available Severe aortic valve stenosis (AVS can cause an exercise-induced reflex syncope (RS. The precise mechanism of this syncope is not known. The changes in hemodynamics are variable, including arrhythmias and myocardial ischemia, and one of the few consistent changes is a sudden fall in systemic and pulmonary arterial pressures (suggesting a reduced vascular resistance followed by a decline in heart rate. The contribution of the cardioinhibitory and vasodepressor components of the RS to hemodynamics was evaluated by a computer model. This lumped-parameter computer simulation was based on equivalent electronic circuits (EECs that reflect the hemodynamic conditions of a heart with severe AVS and a concomitantly decreased contractility as a long-term detrimental consequence of compensatory left ventricular hypertrophy. In addition, the EECs model simulated the resetting of the sympathetic nervous tone in the heart and systemic circuit during exercise and exercise-induced syncope, the fluctuating intra-thoracic pressure during respiration, and the passive relaxation of ventricle during diastole. The results of this simulation were consistent with the published case reports of exertional syncope in patients with AVS. The value of the EEC model is its ability to quantify the effect of a selective and gradable change in heart rate, ventricular contractility, or systemic vascular resistance on the hemodynamics during an exertional syncope in patients with severe AVS.

  13. Laugh syncope as a rare sub-type of the situational syncopes: a case report

    Directory of Open Access Journals (Sweden)

    Nishida Katsufumi

    2008-06-01

    Full Text Available Abstract Introduction Laughter is a good medicine; it enhances cardiovascular health and the immune system. What happens, however, if a person laughs too much or the laughter becomes out of control? Laughter-induced syncope is rare and likely goes unrecognized by many health care providers. It is thought to be another form of Valsalva-induced syncope. Case presentation We report the case of a 56-year-old, moderately obese (body mass index of 35 man with a past medical history of sleep apnea, hypertension and hyperlipidemia who suffered from syncope secondary to intense laughter. The patient also had a history of syncope in the distant past when he collapsed on the floor for several seconds. Treadmill stress testing after the incident revealed no arrhythmia or ischemic disease, although he complained of dizziness after the test and a sudden drop in blood pressure was noted. Conclusion Laughter-induced or gelastic syncope is extremely rare. It is thought to be a sub-type of the situational syncopes.

  14. Worsening of symptoms before presentation with vasovagal syncope.

    Science.gov (United States)

    Sheldon, Robert S; Sheldon, Aaron G; Serletis, Anna; Connolly, Stuart J; Morillo, Carlos A; Klingenheben, Thomas; Krahn, Andrew D; Koshman, Mary-Lou; Ritchie, Debbie

    2007-09-01

    Much of the natural history of vasovagal syncope is unknown. We determined whether patients presenting for care have had a recently worsened syncope frequency. We compared 208 subjects in the referral-based Prevention of Syncope Trial (POST) and 122 subjects who fainted > or =1 in a community survey study. Their mean ages and gender proportions were similar. The POST population had a higher median lifetime syncope frequency (1.16 vs 0.12 spells/year, P or =35 years (26% vs 6%, P or =35 years old had a shorter history than similar community-survey subjects (2.8 vs 14.9 y, P < 0.0001) and presented earlier after their first syncopal spell than POST subjects with a younger onset of syncope (median 2.8 vs 14.7 y, P < 0.0001), despite having fewer faints (median 6 vs 10, P = 0.0002). Many syncope patients present for care after a recent worsening of their frequency of syncope.

  15. Diagnostic yield of device interrogation in the evaluation of syncope in an elderly population.

    Science.gov (United States)

    D'Angelo, Robert N; Pickett, Christopher C

    2017-06-01

    Device interrogation has become a standard part of the syncope evaluation for patients admitted with permanent pacemakers (PPM) or implantable cardiac defibrillators (ICD), although few studies have shown interrogation yields clinically useful data. The purpose of this study is to determine the diagnostic yield of device interrogation as well as other commonly performed tests in the workup of unexplained syncope in patients with previously implanted PPMs or ICDs. We retrospectively reviewed records of 88 patients admitted to our medical center for syncope with previously implanted pacemakers between January 1, 2005 and January 1, 2015 using ICD-9 billing data. Pacemaker interrogation demonstrated an arrhythmia as the cause for syncope in 4 patients (4%) and evidence of device failure secondary to perforation in 1 patient (1%). The cause of syncope was unknown in 34 patients (39%). Orthostatic hypotension was the most commonly identified cause of syncope (26%), followed by vasovagal syncope (13%), autonomic dysfunction (5%), ventricular arrhythmia (3%), atrial arrhythmia (2%), congestive heart failure (2%), stroke (2%), and other less common causes (8%). History was the most important determinant of syncope (36%), followed by orthostatic vital signs (14%), device interrogations (4%), head CT (2%), and transthoracic echocardiogram (1%). Device interrogation is rarely useful for elucidating a cause of syncope without concerning physical exam, telemetry, or EKG findings. Interrogation may occasionally yield paroxysmal arrhythmias responsible for syncopal episode, but these rarely alter clinical outcomes. Interrogation appears to be more useful in patients with syncope after recent device placement. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  16. Neurally mediated syncope in electroconvulsive therapy maintenance.

    Science.gov (United States)

    Arbaizar, Beatriz; Llorca, Javier

    2012-03-01

    Electroconvulsive therapy (ECT) is especially necessary to revert some types of depressive disease; nevertheless, it has some widely recognized adverse effects, such as short-term memory loss. Moreover, some articles have reported its potential association with falls; this literature is, however, scanty and mainly consists of case reports. We present the case of a man who has a diagnosis of neurally mediated syncope at the age of 79 years, during the maintenance ECT. The patient had a significant increase in syncope frequency in the period he was treated with ECT, followed by a dramatic decrease when ECT was discontinued.

  17. Masquerading bundle branch block as a presenting manifestation of complete atrioventricular block that caused syncope.

    Science.gov (United States)

    Jiao, Zhenyu; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

    2017-10-01

    A 59-year-old male patient was admitted with the main complaints of stuffiness and shortness of breath. An ECG from precordial leads on admission showed masquerading bundle branch block. Syncope frequently occurred after admission. During syncope episodes, ECG telemetry showed that the syncope was caused by intermittent complete atrioventricular block, with the longest RR interval lasting for 4.36 s. At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker. Follow-up of 9 months showed no reoccurrence of syncope.

  18. Serum cardiac troponin I in canine syncope and seizures.

    Science.gov (United States)

    Dutton, E; Dukes-McEwan, J; Cripps, P J

    2017-02-01

    To determine if serum cardiac troponin I (cTnI) concentration distinguishes between cardiogenic syncope and collapsing dogs presenting with either generalized epileptic seizures (both with and without cardiac disease) or vasovagal syncope. Seventy-nine prospectively recruited dogs, grouped according to aetiology of collapse: generalized epileptic seizures (group E), cardiogenic syncope (group C), dogs with both epileptic seizures and cardiac disease (group B), vasovagal syncope (group V) or unclassified (group U). Most patients had ECG (n = 78), echocardiography (n = 78) and BP measurement (n = 74) performed. Dogs with a history of intoxications, trauma, evidence of metabolic disorders or renal insufficiency (based on serum creatinine concentrations >150 μmol/L and urine specific gravity disease) or vasovagal syncope. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Syncope as initial symptom for nephrotic syndrome: a case report

    Science.gov (United States)

    Wu, Xuemei; Wang, Guangliang; Feng, Jiachun

    2015-01-01

    Although syncope and nephrotic syndrome are frequently encountered independently in pediatric practice, syncope as the initial symptom for nephrotic syndrome is rarely observed in the pediatric age group. In this report, we present the case of 3-year-old boy with nephrotic syndrome who presented with a history of three episodes of syncope before admission. The syncope occurred after excessive fluid loss or inadequate intake of fluids and was relieved spontaneously. History taking revealed that the early morning palpebral edema, and laboratory tests showed decreased plasma protein levels and elevated serum lipid levels. Nephrotic syndrome was diagnosed, but could not be confirmed histopathologically because the patient’s parent refused consent for biopsy. The patient was managed with fluid expansion, correction of acidosis, and improvement of microcirculation to prevent recurrence of syncope, and glucocorticoids were administered to prevent disease progression. PMID:26629237

  20. Vasovagal Syncope during Epidural Catheterization before ...

    African Journals Online (AJOL)

    The risk factors can be patient related (young, athletics, hypertensive, history of syncope, inferior myocardial infarction and others), anaesthesia related (light anaesthesia, spinal, epidural anaesthesia, airway manipulation, hypercapnia, hypoxia and others) and surgical related (strabismus, anal dilatation, abdominal and ...

  1. Swallow syncope caused by third-degree atrioventricular block

    DEFF Research Database (Denmark)

    Roust Aaberg, Anne Marie; Eriksson, Anna Elin; Madsen, Per Lav

    2015-01-01

    We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker.......We report a case of a patient with more than 30 years of repeated syncopes, always following food intake. The patient was diagnosed with a swallow-related third-degree atrioventricular block and successfully treated with an artificial pacemaker....

  2. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention

    Directory of Open Access Journals (Sweden)

    Ryan J. Koene, MD

    2017-12-01

    Full Text Available Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies; in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD. Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death, and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk. Keywords: Syncope, Sudden cardiac death, Risk assessment

  3. Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal.

    Science.gov (United States)

    Providência, Rui; Candeias, Rui; Morais, Carlos; Reis, Hipólito; Elvas, Luís; Sanfins, Vitor; Farinha, Sara; Eggington, Simon; Tsintzos, Stelios

    2014-05-06

    To estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS). A Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons. The average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP). The utilization of ILR leads to an earlier diagnosis and lower number of syncope hospital admissions and investigations, thus allowing significant cost offsets in the Portuguese setting. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.

  4. Clinical relevance of syncope and presyncope induced by tilt testing.

    Science.gov (United States)

    Zyśko, Dorota; Gajek, Jacek; Koźluk, Edward; Agrawal, Anil Kumar; Smereka, Jacek; Checiński, Igor

    2009-08-01

    The authors investigated the relation between presyncope and syncope induced by tilt testing (HUTT) and demographics, medical history and HUTT data.The demographics, syncopal burden, data regarding the spontaneous syncope and reproduction of symptoms during HUTT were compared among patients with induced syncope and presyncope. The study group consisted of 574 patients (371 women, 203 men), aged 43.7 +/- 18.5 years. Patients with syncope induced by HUTT (418 patients, 63.9% women) had a higher number of syncopal episodes in their medical history. Stepwise logistic regression revealed that syncope provocation was independently related to the cardiodepressive type of neurocardiogenic reaction (OR 7.8, CI 4.2-14.4, P < 0.001), NTG use (OR 1.7, CI: 1.0-2.7, P < 0.05), the reproduction of the symptoms during HUTT (OR 2.0, CI: 1.3-3.1, P < 0.01) and the higher number of syncopal episodes (OR 2.0, CI: 1.3-3.0, P < 0.01). In patients with positive HUTT during a passive phase it was related to the cardiodepressive type of reaction (OR 26.5, CI: 5.9-118.5, P < 0.001). In the group with positive HUTT after NTG syncope was related to the cardiodepressive type (OR 5.7, CI: 2.9-11.2, P < 0.001), vasovagal history (OR 2.0, CI: 1.2-3.3, P < 0.01), reproduction of the spontaneous symptoms (OR 1.9, CI: 1.1-3.1, P < 0.05) and higher number of syncopal episodes (OR 2.1, CI: 1.3-3.3, P < 0.01). Syncope is more frequently a HUTT outcome than presyncope. The provocation of syncope in the passive phase of HUTT depends only on the cardiodepressive type of neurocardiogenic reaction. The induction of presyncope after nitroglycerin provocation is related to the possibility of a false positive reaction.

  5. Syncopation, body-movement and pleasure in groove music.

    Science.gov (United States)

    Witek, Maria A G; Clarke, Eric F; Wallentin, Mikkel; Kringelbach, Morten L; Vuust, Peter

    2014-01-01

    Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a web-based survey which investigated the relationship between syncopation and ratings of wanting to move and experienced pleasure. Participants heard funk drum-breaks with varying degrees of syncopation and audio entropy, and rated the extent to which the drum-breaks made them want to move and how much pleasure they experienced. While entropy was found to be a poor predictor of wanting to move and pleasure, the results showed that medium degrees of syncopation elicited the most desire to move and the most pleasure, particularly for participants who enjoy dancing to music. Hence, there is an inverted U-shaped relationship between syncopation, body-movement and pleasure, and syncopation seems to be an important structural factor in embodied and affective responses to groove.

  6. Syncopation, body-movement and pleasure in groove music.

    Directory of Open Access Journals (Sweden)

    Maria A G Witek

    Full Text Available Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a web-based survey which investigated the relationship between syncopation and ratings of wanting to move and experienced pleasure. Participants heard funk drum-breaks with varying degrees of syncopation and audio entropy, and rated the extent to which the drum-breaks made them want to move and how much pleasure they experienced. While entropy was found to be a poor predictor of wanting to move and pleasure, the results showed that medium degrees of syncopation elicited the most desire to move and the most pleasure, particularly for participants who enjoy dancing to music. Hence, there is an inverted U-shaped relationship between syncopation, body-movement and pleasure, and syncopation seems to be an important structural factor in embodied and affective responses to groove.

  7. Use of implantable and external loop recorders in syncope with unknown causes

    Directory of Open Access Journals (Sweden)

    Kaoru Tanno

    2017-12-01

    Full Text Available The gold standard for diagnosing syncope is to elucidate the symptom-electrocardiogram (ECG correlation. The ECG recordings during syncope allow physicians to either confirm or exclude an arrhythmia as the mechanism of syncope. Many studies have investigated the use of internal loop recorder (ILR, while few studies have used external loop recorder (ELR for patients with unexplained syncope. The aim of this review is to clarify the clinical usefulness of ILR and ELR in the diagnosis and management of patients with unexplained syncope. Many observational and four randomized control studies have shown that ILR for patients with unknown syncope is a useful tool for early diagnosis and improving diagnosis rate. ILR also provides important information on the mechanism of syncope and treatment strategy. However, there is no evidence of total mortality or quality of life improvements with ILR. The diagnostic yield of ELR in patients with syncope was similar to that with ILR within the same timeframe. Therefore, ELR could be considered for long-term ECG monitoring before a patient switches to using ILR. A systematic approach and selection of ECG monitoring tools reduces health care costs and improves the selection of patients for optimal treatment possibilities. Keywords: Internal loop recorder, External loop recorder, Unknown Syncope

  8. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    Energy Technology Data Exchange (ETDEWEB)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar [University Hospital Hamburg Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Muench, Julia; Patten, Monica [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany); DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg (Germany); Saering, Dennis [University of Applied Sciences, Information Technology and Image Processing, Wedel (Germany); Stehning, Christian [Philips Research, Hamburg (Germany); Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai [University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg (Germany)

    2017-12-15

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  9. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR

    International Nuclear Information System (INIS)

    Avanesov, Maxim; Weinrich, Julius; Well, Lennart; Tahir, Enver; Adam, Gerhard; Lund, Gunnar; Muench, Julia; Patten, Monica; Saering, Dennis; Stehning, Christian; Bohnen, Sebastian; Radunski, Ulf K.; Muellerleile, Kai

    2017-01-01

    To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. (orig.)

  10. Syncopation, body-movement and pleasure in groove music.

    OpenAIRE

    Witek, MA; Clarke, EF; Wallentin, M; Kringelbach, ML; Vuust, P

    2014-01-01

    Moving to music is an essential human pleasure particularly related to musical groove. Structurally, music associated with groove is often characterised by rhythmic complexity in the form of syncopation, frequently observed in musical styles such as funk, hip-hop and electronic dance music. Structural complexity has been related to positive affect in music more broadly, but the function of syncopation in eliciting pleasure and body-movement in groove is unknown. Here we report results from a ...

  11. [Treatment of recurrent neurocardiogenic syncope with cardiac inhibitors with ipratropium bromide].

    Science.gov (United States)

    Friederich, H-C; Michaelsen, J; Hesse, C; Schellberg, D; Schwab, M; Herzog, W

    2004-06-01

    Pharmacological approaches for the treatment of cardioinhibitory vasovagal syncope are controversially discussed in the literature. In acute treatment of neurocardiogenic syncope, anticholinergics (atropine) are used effectively. Randomised and placebo-controlled clinical trials evaluating the preventive significance of anticholinergic agents in the therapy of cardioinhibitory vasovagal syncope are still missing. We report the case of an 18-year-old male patient with recurrent convulsive, cardioinhibitory neurocardiogenic syncope. Vasovagal syncope occurred predominantly as centrally induced syncope triggered by negative emotions such as fear or by seeing blood. Under resting conditions, the patient revealed increased parasympathetic tone with nocturnal bradycardia of 38 beats/min. In the course of head-up tilt table testing a cardioinhibitory syncope with an asystolic pause of 10 seconds occurred without any prodromes after 10 minutes of upright positioning. In order to inhibit parasympathetic tone, medication with ipratropiumbromide was initiated. Time-variant analysis of heart rate variability (autoregressive model) during head-up tilt table testing showed under the medication with ipratropiumbromide a vagal mediated cardioinhibition to 56 beats/min, but no further sinus arrest. Throughout clinical follow-up of 6 months the patient remained syncope-free under the medication. The usefulness of ipratropiumbromide in inhibiting vagal mediated cardioinhibition will be discussed referring to the case report and to studies evaluating anticholinergic agents in the treatment of neurocardiogenic syncope.

  12. Reliability of Left Ventricular Hypertrophy by ECG Criteria in Children with Syncope: Do the Criteria Need to be Revised?

    Science.gov (United States)

    Banerjee, Maalika M; Ramesh Iyer, V; Nandi, Deipanjan; Vetter, Victoria L; Banerjee, Anirban

    2016-04-01

    In the outpatient setting, children who present with syncope routinely undergo electrocardiograms (ECG). Because of concerns for hypertrophic cardiomyopathy, children with syncope meeting ECG criteria for left ventricular hypertrophy (LVH) will frequently undergo an echocardiogram. Our objectives were to determine whether Davignon criteria for ECG waves overestimate LVH in children presenting with syncope, and to study the usefulness of echocardiography in these children. We hypothesize that the Davignon criteria presently used for interpretation of ECGs overestimate LVH, resulting in unnecessary echocardiography in this clinical setting. The clinical database of The Children's Hospital of Philadelphia was evaluated from 2002 to 2012 to identify children between 9 and 16 years of age, who presented with non-exercise-induced, isolated syncope. From this group of patients, only those with clear-cut evidence of LVH (by Davignon criteria), who also underwent an echocardiogram, were selected. A total of 136 children with syncope were identified as having LVH by Davignon ECG criteria. None of these patients manifested any evidence of hypertrophic cardiomyopathy, with normal ventricular septum (average Z-score -0.68 ± 0.84), LV posterior wall (average Z-score -0.66 ± 1.18) and LV mass (average Z-score 0.52 ± 1.29). No significant correlation was found between summed RV6 plus SV1 and LV mass. Correlations between additional ECG parameters and measures of LVH by echocardiography were similarly poor. In children presenting with syncope and LVH by ECG, there was no evidence of true LVH by echocardiography. We propose that the Davignon ECG criteria for interpreting LVH in children overestimate the degree of hypertrophy in these children and the yield of echocardiography is extremely low.

  13. Fluoxetine vs. placebo for the treatment of recurrent vasovagal syncope with anxiety sensitivity.

    Science.gov (United States)

    Flevari, Panayota; Leftheriotis, Dionyssios; Repasos, Evangelos; Katsaras, Dimitrios; Katsimardos, Andreas; Lekakis, John

    2017-01-01

    The optimal medical therapy of patients with vasovagal syncope (VVS) remains controversial. Fluoxetine is effective against anxiety and panic disorders, while its use has shown promising results for VVS. Anxiety sensitivity is a personality trait observed in a considerable proportion of patients with VVS, associated with predisposition to anxiety and panic disorders. Our aim was to examine whether fluoxetine exerts beneficial effects regarding VVS prevention in the subset of patients with anxiety sensitivity. We assessed 106 patients with typical history of recurrent VVS, without other comorbidities, and a diagnostic, positive head-up tilt test. A psychiatric examination ruled out clinical psychiatric disease. Their psychological, stress-related profile was assessed by the Anxiety Sensitivity Index (ASI) questionnaire, a 16-item questionnaire, assessing fear of anxiety-related sensations, previously studied in VVS. Patients scoring positive for ASI (n = 60, 57% of the population) were randomized in a 2:1 fashion to receive either 10-40 mg fluoxetine daily (n = 40) or placebo (n = 20), and were followed-up for 1 year. A significant difference was observed between patients receiving fluoxetine and those with placebo, regarding the distribution of syncope-free time during the study (P Fluoxetine is superior to placebo against syncope in these patients. This drug may be a first-line pharmacological treatment for this difficult-to-treat group. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  14. Implantable loop recorders for assessment of syncope: increased diagnostic yield and less adverse outcomes with the latest generation devices.

    Science.gov (United States)

    Bartoletti, A; Bocconcelli, P; De Santo, T; Ghidini Ottonelli, A; Giuli, S; Massa, R; Svetlich, C; Tarsi, G; Corbucci, G; Tronconi, F; Vitale, E

    2013-08-01

    Aim of the study was to compare the diagnostic yield of implantable loop recorders (ILR) of two successive generations for the assessment of syncope. Data on patients who had undergone ILR implantation for unexplained syncope in four Italian public hospitals were retrospectively acquired from the Medtronic Clinical Service database. After implantation, routine follow-up examinations were performed every 90 days, while urgent examinations were carried out in the event of syncope recurrence. The following findings were regarded as diagnostic: ECG documentation of a syncope recurrence; documentation of any of the arrhythmias listed by the current guidelines as diagnostic findings even if asymptomatic. Between November 2002 and March 2010, 107 patients received an ILR (40 Medtronic Reveal® Plus; 67 Medtronic Reveal® DX/XT) and underwent at least one follow-up examination. Diagnoses were made in 7 (17.5%) and 24 (35.8%) (P=0.043) patients, with a median time of 228 and 65 days, respectively. Three (42.9%) and 21 (87.5%) (P=0.029) diagnoses were based on automatically detected events, while adverse outcomes occurred in 6 and in 1 (P=0.01) patients, respectively. Our results show that the new-generation device offer a higher diagnostic yield, mainly as a result of its improved automatic detection function, and is associated with fewer adverse outcomes.

  15. Influence of climate on emergency department visits for syncope: role of air temperature variability.

    Directory of Open Access Journals (Sweden)

    Andrea Galli

    Full Text Available BACKGROUND: Syncope is a clinical event characterized by a transient loss of consciousness, estimated to affect 6.2/1000 person-years, resulting in remarkable health care and social costs. Human pathophysiology suggests that heat may promote syncope during standing. We tested the hypothesis that the increase of air temperatures from January to July would be accompanied by an increased rate of syncope resulting in a higher frequency of Emergency Department (ED visits. We also evaluated the role of maximal temperature variability in affecting ED visits for syncope. METHODOLOGY/PRINCIPAL FINDINGS: We included 770 of 2775 consecutive subjects who were seen for syncope at four EDs between January and July 2004. This period was subdivided into three epochs of similar length: 23 January-31 March, 1 April-31 May and 1 June-31 July. Spectral techniques were used to analyze oscillatory components of day by day maximal temperature and syncope variability and assess their linear relationship. There was no correlation between daily maximum temperatures and number of syncope. ED visits for syncope were lower in June and July when maximal temperature variability declined although the maximal temperatures themselves were higher. Frequency analysis of day by day maximal temperature variability showed a major non-random fluctuation characterized by a ∼23-day period and two minor oscillations with ∼3- and ∼7-day periods. This latter oscillation was correlated with a similar ∼7-day fluctuation in ED visits for syncope. CONCLUSIONS/SIGNIFICANCE: We conclude that ED visits for syncope were not predicted by daily maximal temperature but were associated with increased temperature variability. A ∼7-day rhythm characterized both maximal temperatures and ED visits for syncope variability suggesting that climate changes may have a significant effect on the mode of syncope occurrence.

  16. Priorities for emergency department syncope research

    NARCIS (Netherlands)

    Sun, Benjamin C.; Costantino, Giorgio; Barbic, Franca; Bossi, Ilaria; Casazza, Giovanni; Dipaola, Franca; McDermott, Daniel; Quinn, James; Reed, Matthew; Sheldon, Robert S.; Solbiati, Monica; Thiruganasambandamoorthy, Venkatesh; Krahn, Andrew D.; Beach, Daniel; Bodemer, Nicolai; Brignole, Michele; Casagranda, Ivo; Duca, Piergiorgio; Falavigna, Greta; Ippoliti, Roberto; Montano, Nicola; Olshansky, Brian; Raj, Satish R.; Ruwald, Martin H.; Shen, Win-Kuang; Stiell, Ian; Ungar, Andrea; van Dijk, J. Gert; van Dijk, Nynke; Wieling, Wouter; Furlan, Raffaello

    2014-01-01

    There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of

  17. [Vasovagal syncope as a cause of serious body injury - two case reports].

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota

    2003-04-01

    Vasovagal syncope is a reflex reaction, leading to marked hypotension and/or bradycardia with transient loss of consciousness and the postural muscle tone. The recovery is spontaneous and usually rapid. Serious body injuries caused by fainting are rare. We present two patients with vasovagal syncope which caused serious injury. Different therapeutic options, including pacemaker implantation, are discussed.

  18. Perioperative Vasovagal Syncope with Focus on Obstetric Anesthesia

    Directory of Open Access Journals (Sweden)

    Pei-Shan Tsai

    2006-09-01

    Full Text Available Vasovagal syncope refers to a reflex cardiovascular depression that gives rise to loss of consciousness with bradycardia and profound vasodilatation. This response commonly occurs during regional anesthesia, hemorrhage or supine inferior vena cava compression in pregnancy. The changes in circulatory response from the normal maintenance of arterial pressure to parasympathetic activation and sympathetic inhibition may cause severe hypotension. This change is triggered by reduced cardiac venous return as well as episodes of emotional stress, excitement or pain. Occasionally, these vasovagal responses may be unpredictable and may dramatically proceed to asystole with circulatory collapse, and may even result in death. In these circumstances, hypotension may be more severe than that caused by bradycardia alone, because of unappreciated vasodilatation. Regional anesthesia, decreased venous return, hemorrhage and abnormal fetal presentation cumulatively increase the risk of vasovagal syncope in cesarean section patients. When a vasovagal response occurs, ephedrine is the drug of first choice because of its combined action on the heart and peripheral blood vessels. Epinephrine must be used early in established cardiac arrest, especially after high regional anesthesia.

  19. Treatment of vasovagal syncope: pacemaker or crossing legs?

    NARCIS (Netherlands)

    van Dijk, N.; Harms, M. P.; Linzer, M.; Wieling, W.

    2000-01-01

    A 50-year-old male patient continued to experience syncope after implantation of a pacemaker. During cardiovascular examination, the patient showed a typical vasovagal response, with normal pacemaker function. Leg crossing, which prohibits the pooling of blood in the legs and abdomen, at the onset

  20. Reninoma presenting as cardiac syncope

    Science.gov (United States)

    Tak, Shahid I; Wani, Mohd Lateef; Khan, Khursheed A; Alai, Mohd Sultan; Shera, Altaf Hussain; Ahangar, Abdul G; Khan, Yasir Bashir; Nayeem-ul-Hassan; Irshad, Ifat

    2011-01-01

    Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia. PMID:21677812

  1. The pattern of activation of the sympathetic nervous system during tilt-induced syncope.

    Science.gov (United States)

    Zyśko, Dorota; Gajek, Jacek; Sciborski, Ryszard; Smereka, Jacek; Checiński, Igor; Mazurek, Walentyna

    2007-04-01

    A 49-year-old patient with a history of situational syncope and minimal electrocardiographic signs of accessory pathway is described. The evidence for pre-excitation was present only during the sympathetic activation caused by exercise testing and isoprenaline infusion. This phenomenon served as an indicator of significant adrenergic drive to the heart after the tilt-induced syncope. The meaning of the observed electrocardiographic changes in the course of neurocardiogenic reaction and its contribution to the understanding of the sympatho-vagal balance during vasovagal syncope is discussed. The lack of preexcitation signs during syncope and its appearance several seconds after the syncope-related sinus pause indicates sympathetic withdrawal before and shortly after the asystole. The possible pathophysiological mechanisms are discussed.

  2. Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

    Directory of Open Access Journals (Sweden)

    Pasqualetti G

    2017-04-01

    . These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall. Keywords: older people, frailty, fall, accidental fall, syncope

  3. The Effects of Parkinson's Disease and Age on Syncopated Finger Movements

    Science.gov (United States)

    Stegemöller, Elizabeth L.; Simuni, Tanya; MacKinnon, Colum

    2009-01-01

    In young healthy adults, syncopated finger movements (movements between consecutive beats) are characterized by a frequency-dependent change in phase at movement rates near 2 Hz. A similar frequency-dependent phase transition is observed during bimanual anti-phase (asymmetric) tasks in healthy young adults, but this transition frequency is significantly lowered in both patients with Parkinson's disease (PD) and older adults. To date, no study has examined the transition frequency associated with unimanual syncopated movements in patients with PD or older adults. This study examined the effects of movement frequency on the performance of unconstrained syncopated index finger flexion movements in patients with PD, older adult subjects matched to patients with PD, and young adult subjects. Syncopated movements were paced by an acoustic tone that increased in frequency from 1 to 3 Hz in 0.25 Hz increments. Movement phase was quantified and the movement frequency where subjects transitioned from syncopation to synchronization was compared between groups. The principal finding was a marked impairment in the ability of patients with PD to perform syncopated movements when off medication. Medication did not significantly improve performance. In addition, the transition frequency for older adult subjects was lower than young adult subjects. These findings demonstrate that, similar to bimanual tasks, the coordination dynamics associated with unimanual syncopated finger movements transition from a stable to an unstable pattern at significantly lower frequencies in patients with PD and older adults compared to young adults. PMID:19596277

  4. Head up tilt test in the diagnosis of neurocardiogenic syncope in childhood and adolescence.

    Science.gov (United States)

    Udani, Vrajesh; Bavdekar, Manisha; Karia, Samir

    2004-06-01

    Neurocardiogenic syncope (NCS) is a common paroxysmal disorder that is often misdiagnosed as a seizure disorder. Head up tilt test (HUTT) has been used to confirm this diagnosis. There is no data available of its use in children / adolescents from India. To study the usefulness of the HUTT in children and adolescents with suspected NCS. This was a part retrospective and later prospective study set in a tertiary child neurology outpatient department (OPD). Patients with a strong clinical suspicion of syncope were recruited for the study. Clinical and treatment details were either retrieved from the chart or prospectively recorded in later patients. The HUTT was then carried out at baseline and after provocation and the results correlated with the clinical diagnosis. Eighteen children with a mean age of 10.8 years were studied. Eight had precipitating factors. Thirteen had premonitory symptoms. Pallor, temperature change, diaphoresis, headache, tonic / clonic movements, post-ictal confusion and peri-ictal headache were symptoms noticed. Sixteen had a positive HUTT. Seven were on long-term anti-epileptic drugs (AEDs). Two had epileptiform abnormalities on their electroencephalogram (EEG). The diagnosis of syncope is often confused with epilepsy. Head up tilt test has a high sensitivity in the diagnosis of NCS in children / adolescents. It is fairly safe and easy to perform.

  5. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

    DEFF Research Database (Denmark)

    Fanoe, Søren; Hvidt, C; Ege, P

    2007-01-01

    were collected in a population of adult heroin addicts treated with methadone or buprenorphine on a daily basis. Of the patients at the Drug Addiction Service in the municipal of Copenhagen, 450 ( 52%) were included. The QT interval was estimated from 12 lead ECGs. All participants were interviewed...

  6. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen

    DEFF Research Database (Denmark)

    Fanoe, Søren; Hvidt, Christian; Ege, Peter Preben

    2007-01-01

    Methadone is prescribed to heroin addicts to decrease illicit opioid use. Prolongation of the QT interval in the ECG of patients with torsade de pointes (TdP) has been reported in methadone users. As heroin addicts sometimes faint while using illicit drugs, doctors might attribute too many episodes...

  7. Selected problems that may be thecause of cardiogenic syncope in children and adolescents. Useful information for family doctor and paediatrician

    Directory of Open Access Journals (Sweden)

    Aleksandra Morka

    2014-12-01

    Full Text Available Children with syncope are common patients in paediatric and family doctor clinics as well as emergency departments. The current guidelines of the European Society of Cardiology (2009 distinguish between three types of syncope: reflex, orthostatic hypotension and cardiac syncope. The essence of any syncope is the reduction of cerebral blood flow, loss of consciousness and a subsequent fall. The most common and the mildest form of syncope is reflex syncope, usually preceded by prodromal symptoms, while the rarest but also the most dangerous form is cardiac syncope. Cardiac syncopes are generally organic in origin and it is usually possible to determine their cause. In some cases it is possible to treat the cause of cardiac syncopes. They differ from reflex syncopes in the mechanism of origin: they usually do not have prodromal symptoms, and sometimes the first symptom of an ongoing disease can be syncope and even sudden cardiac death. Cardiac syncope affects patients with cardiac arrhythmias – tachy- or bradyarrhythmias, patients who suffer from malfunction of a previously implanted pacemaker, patients with defects that cause disturbed outflow from the right or the left ventricle, patients with defects and diseases of the heart muscle and/or coronary vessels as well as abnormalities causing impediment to the flow of blood within the heart or vessels (e.g. tumours. Some of these diseases such as, for example, hypertrophic cardiomyopathy or long QT syndrome are genetic abnormalities. In cardiac syncope, as in other types of syncope it is important to obtain a detailed family history and perform specialised tests. In recent years tilt tests have been increasingly less used and emphasis has been put on a very detailed diagnosis of cardiac arrhythmias as a potential cause of syncope and sudden cardiac death. Every patient with a suspected cardiac syncope should be referred to a specialist centre for

  8. A novel psychophysiological treatment for vasovagal syncope.

    Science.gov (United States)

    Khurana, R K; Lynch, J J; Craig, F W

    1997-08-01

    The objective of this study was to evaluate the efficacy of transactional psychophysiological therapy (TPT) in a patient with recurrent vasovagal syncope (VVS) and to quantify the capacity of human dialogue to effect significant and consistent measurable therapeutic cardiovascular (CV) changes. A 31-year-old nurse with recurrent VVS and a reproducibly abnormal tilt-table test was refractory to pharmacological and conventional psychiatric treatments. She was treated with TPT. Her CV responses during psychotherapy were incorporated into the dialogue as an important source of communicative information, and she was taught psychophysiological techniques to correct exaggerated CV responses. These responses, during 16 weekly and 12 subsequent monthly sessions, were analysed using a one-way multiple analysis of variance. As TPT progressed, the magnitude and lability of CV responses as well as frequency of VVS were reduced. She has been relatively asymptomatic for 14 years posttherapy. In conclusion, (1) TPT may be an effective primary/adjunctive treatment for patients with VVS; (2) TPT may reduce syncopal episodes, perhaps by normalizing limbic input to the brainstem baroreflex system.

  9. Diagnostic value of history taking in reflex syncope

    NARCIS (Netherlands)

    Colman, N.; Nahm, K.; van Dijk, J. G.; Reitsma, J. B.; Wieling, W.; Kaufmann, H.

    2004-01-01

    The medical history, in combination with the physical examination and a 12-lead electrocardiogram, plays a key role in the diagnosis and risk stratification of patients with syncope. However, diagnostic clinical criteria are not uniformly applied. In older studies, the diagnostic criteria for

  10. Tilt table testing in patients with suspected epilepsy1

    DEFF Research Database (Denmark)

    Edfors, R.; Erdal, J.; Rogvi-Hansen, B.

    2008-01-01

    BACKGROUND: Approximately 20-30% of patients with epilepsy are misdiagnosed and syncope often seems to be the mistaken cause. We re-evaluated patients referred to an epilepsy clinic where suspicion of neurally mediated (reflex) syncope were raised using tilt table testing (HUT). METHODS: HUT...... laboratory results and medical records of 120 consecutive patients were reviewed retrospectively over a period of 27 months. RESULTS: HUT was positive in 59 (49%) patients. Seventeen of 38 (45%) patients previously diagnosed with epilepsy and taking antiepileptic drugs were found to be misdiagnosed. Four...... of 21 patients with epilepsy (19%) had dual diagnoses of reflex syncope and epilepsy. CONCLUSION: HUT is an informative investigation when suspicions of reflex syncope are raised in patients referred to an epilepsy clinic. Reflex syncope is an important and common differential diagnosis of epilepsy...

  11. Use of Implantable Loop Recorders to Unravel the Cause of Unexplained Syncope

    Directory of Open Access Journals (Sweden)

    Dr. Aniket Puri, DM, FACC, FAPSIC, FSCAI

    2013-03-01

    Full Text Available Syncope is a symptom of many underlying disease states, which range from the relatively benign to the life threatening. There are numerous investigations done for patients with recurrent unexplained syncope which may have very low yield when it comes to making a definitive diagnosis. Recently, the implantable loop recorder (ILR for continuous monitoring of the cardiac rhythm has been launched in India. This review will briefly discuss these current availabel strategies and focus on the usefulness of an ILR in the definitive diagnosis and treatment of patients with a recurrent unexplained syncope.

  12. Self-induced stretch syncope of adolescence: a video-EEG documentation.

    Science.gov (United States)

    Mazzuca, Michel; Thomas, Pierre

    2007-12-01

    We present the first video-EEG documentation, with ECG and EMG features, of stretch syncope of adolescence in a young, healthy 16-year-old boy. Stretch syncope of adolescence is a rarely reported, benign cause of fainting in young patients, which can be confused with epileptic seizures. In our patient, syncopes were self-induced to avoid school. Dynamic transcranial Doppler showed evidence of blood flow decrease in both posterior cerebral arteries mimicking effects of a Valsalva manoeuvre. Dynamic angiogram of the vertebral arteries was normal. Hypotheses concerning the physiopathology are discussed. [Published with video sequences].

  13. Syncope- a common challenge to medical practitioners ...

    African Journals Online (AJOL)

    Syncope is a common presentation in medical practice, and is associated with a higher than normal risk of mortality and morbidity in older individuals; It is essential that an accurate clinical history of the episode described as syncope be obtained, including the events preceding, the observations of eye-witnesses, and the ...

  14. Effects of the menstrual cycle phases on the tilt testing results in vasovagal patients.

    Science.gov (United States)

    Zyśko, Dorota; Gajek, Jacek; Terpiłowski, Lukasz; Agrawal, Anil Kumar; Wróblewski, Paweł; Rudnicki, Jerzy

    2012-08-01

    The aim of the study was to assess the distribution of positive tilt testing (TT) throughout the menstrual cycle and to determine if the phase of menstrual cycle contributes to the duration of the loss of consciousness. TT results of 183 premenopausal women, aged 29.5 ± 9.8 years, were studied. The menstrual cycle was divided into four phases based on the first day of the last menstrual bleeding: perimenstrual (M), preovulatory (F), periovulatory (O) and postovulatory (L). Positive TT results were equally distributed. In patients with TT in O phase, the highest percentage of NTG provocation was needed. Patients in L phase had significantly lower incidence of cardioinhibitory reaction. The longest duration of loss of consciousness was in the M phase. Multiple regression analysis revealed that the duration of loss of consciousness during positive TT was significantly associated with higher number of syncopal events, TT performed in M phase and lower heart rate at TT termination. Cardiodepressive type of neurocardiogenic reaction was more frequent during M and O phase than during L phase. The distribution of positive TT results as well as syncope and presyncope does not differ throughout the menstrual cycle. Diagnostic TT in premenopausal women with unexplained syncope could be performed irrespective of the phase of menstrual cycle. TT has similar sensitivity throughout the menstrual cycle. During the postovulatory phase, cardioinhibitory reaction is less frequent than in M and O phases. The duration of loss of consciousness is longer during the M phase of the menstrual cycle independently of the higher syncope number and lower heart rate at TT termination.

  15. A CASE OF THE SELF- HARMING BEHAVIOUR CREATED WITH COMPULSIVE SYNCOPE EPISODES

    Directory of Open Access Journals (Sweden)

    Cetiner OZCAN

    2011-06-01

    Full Text Available In this case report, self-harming behavioural pattern with recurrent syncope episodes in a 15 years old adolescent has been reviewed. In self-harm behavior, tissue damage can often be seen macroscopically. Whereas in this case, the extraordinary situation is possibility of occurrence of the hypoxic encephalopathyc changes with syncope episodes created by the patient, without macroscopic tissue damage. [J Contemp Med 2011; 1(2.000: 78-80

  16. [Syncope and work: role of the occupational physician and global risk stratification].

    Science.gov (United States)

    Barbic, F; Angaroni, L; Orlandi, M; Costantino, G; Dipaola, E; Borleri, D; Borchini, R; D'Adda, F; Perego, F; Borella, M; Galli, A; Solbiati, M; Scanella, E; Casazza, G; Seghizzi, P; Furlan, R

    2011-01-01

    Safety risk for subjects suffering from syncope while working has not been as yet addressed by occupational medicine. The present study was aimed at evaluating a new developed methodology for job tasks risk stratification in patients with syncope. During a work-shop on syncope and occupational risk, 149 occupational physicians (OP) with about 10 years of clinical experience were asked to fulfil a Visual Analogue Scale (VAS) concerning the doctor's estimated potential damage (D) to the worker and the probability of a damage to occur (P) should syncope take place during the job task. Five job tasks characterized by different risk for safety (1, driving; 2, toxic products handling; 3, job performed closed to hot surfaces o free flames; 4, surgical activity; 5, office job) were identified. OP correctly stratified the risk associated to the different job tasks in patients with syncope. Unexpectedly, task #3 was given a risk similar to that obtained in drivers. This might be of paramount clinical and social importance when patients with syncope have to return to their job tasks.

  17. Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2001-01-01

    Full Text Available Syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and cathecolaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.

  18. Syncope in old people. The importance of multiparametric monitor in OBI evaluation

    Directory of Open Access Journals (Sweden)

    Alessandro Riccardi

    2006-10-01

    Full Text Available Syncope is a common clinical entity, and it causes up to 3% of admission in the Emergency Department. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography, with a correct identification of etiology at the presentation in up to 50% of cases. Moreover, the underlying cause of syncope remains unidentified in a elevated percentage of patients. The application of Standard Guidelines and the institution of the Observation Unit (OBI with continuous monitoring improves patients management, chiefly in the geriatric population (> 65 years old. In older patients the clinical features of syncope are less defined, and the medical history has a limited value. The management in the OBI of this group of patient with continuous monitoring could become the best approach. The ECG monitoring can detect life-threatening arrhythmias in older patients with apparent non cardiac syncope. In the firs six months of 2005 the Emergency Department of the Ospedale San Paolo (Savona evaluated 164 patients > 65 years old with diagnosis of syncope/pre-syncope. During monitoring we detected events of arrhythmia in 12 patients (7,3%, including ventricular tachycardia in 2, atrial fibrillation in 4, paroxysmal atrial flutter in 2, paroxysmal supraventricular tachycardia in 1, asystole in 1 and third-degree atrioventricular block in 2 patients. We briefly describe 2 of this case: in both cases the first suggestion indicates a possible non cardiac etiology, but the subsequent monitoring shows episodes of potentially fatal arrhythmia. Both an early discharge and an in non-monitorized bed admission wouldn’t have preserved the two patient by a sudden cardiac death.

  19. Syncope

    Science.gov (United States)

    ... Circulation My alerts Sign In Join Sign out Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Doodle Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  20. Delta space plot analysis of cardiovascular coupling in vasovagal syncope during orthostatic challenge.

    Science.gov (United States)

    Reulecke, S; Charleston-Villalobos, S; Voss, A; Gonzalez-Camarena, R; Gaitan-Gonzalez, M; Gonzalez-Hermosillo, J; Hernandez-Pacheco, G; Aljama-Corrales, T

    2016-08-01

    In this work, a graphical method to study cardiovascular coupling, called delta space plot analysis (DSPA), was introduced. The graphical representation is susceptible to be parameterized in shape and orientation. The usefulness of this technique was studied on cardiovascular data from patients with vasovagal syncope (VVS) and from controls. The study included 15 female patients diagnosed with VVS and 11 age-matched healthy female subjects. All subjects were enrolled in a head-up tilt (HUT) test, breathing normally, including 5 minutes of supine position (baseline) and 18 minutes of 70° orthostatic phase. The DSPA parameters were obtained at different times during the HUT test, i.e., at baseline, early (first 5 min) and late (10-15 min) orthostatic phases. In baseline there were no considerable differences between female controls and female patients. During the late orthostatic phase, parameters from DSPA showed highly significantly (p=0.000003) reduced cardiovascular coupling in patients. Findings indicated a loss of control on cardiovascular coupling in female patients susceptible to vasovagal syncope during orthostatic challenge. In addition, this study provided promising results for a new graphical method to investigate cardiovascular coupling.

  1. Intermittent Brugada Syndrome Presenting with Syncope in an Adult Female

    Directory of Open Access Journals (Sweden)

    Patricia Chavez

    2014-01-01

    Full Text Available Background. Brugada syndrome accounts for 4–12% of all sudden deaths worldwide and at least 20% of sudden deaths in patients with structurally normal hearts. Case Report. A 48-year-old female presented to the emergency department after two witnessed syncopal episodes. While awaiting discharge had a third collapse followed by cardiac arrest with shockable rhythm. Initial electrocardiogram showed wide QRS complex with left axis deviation, ST-segment elevation of 2 mm followed by a negative T wave with no isoelectric separation, suggestive of spontaneous intermittent Brugada type 1 pattern. Cardiac magnetic resonance imaging demonstrated neither structural heart disease nor abnormal myocardium. After placement of an implantable cardioverter defibrillator the patient was discharged. Why should an emergency physician be aware of this? Brugada syndrome is an infrequently encountered clinical entity which may have a fatal outcome. This syndrome primarily presents with syncope. It should be considered as a component of differential diagnosis in patients with family history of syncope and sudden cardiac death.

  2. Alteration of gene expression profiling including GPR174 and GNG2 is associated with vasovagal syncope.

    Science.gov (United States)

    Huang, Yu-Juan; Zhou, Zai-wei; Xu, Miao; Ma, Qing-wen; Yan, Jing-bin; Wang, Jian-yi; Zhang, Quo-qin; Huang, Min; Bao, Liming

    2015-03-01

    Vasovagal syncope (VVS) causes accidental harm for susceptible patients. However, pathophysiology of this disorder remains largely unknown. In an effort to understanding of molecular mechanism for VVS, genome-wide gene expression profiling analyses were performed on VVS patients at syncope state. A total of 66 Type 1 VVS child patients and the same number healthy controls were enrolled in this study. Peripheral blood RNAs were isolated from all subjects, of which 10 RNA samples were randomly selected from each groups for gene expression profile analysis using Gene ST 1.0 arrays (Affymetrix). The results revealed that 103 genes were differently expressed between the patients and controls. Significantly, two G-proteins related genes, GPR174 and GNG2 that have not been related to VVS were among the differently expressed genes. The microarray results were confirmed by qRT-PCR in all the tested individuals. Ingenuity pathway analysis and gene ontology annotation study showed that the differently expressed genes are associated with stress response and apoptosis, suggesting that the alteration of some gene expression including G-proteins related genes is associated with VVS. This study provides new insight into the molecular mechanism of VVS and would be helpful to further identify new molecular biomarkers for the disease.

  3. The choice of surgical specialization by medical students and their syncopal history.

    Directory of Open Access Journals (Sweden)

    Jerzy Rudnicki

    Full Text Available BACKGROUND: The aim of the study was to assess whether medical students' fainting outside the university or while witnessing surgical procedures and/or autopsies influenced their choice of a specialization. MATERIALS AND METHODS: The study group consisted of 605 medical students (from fourth to sixth year of study from five medical universities in Poland (325 women, 212 men and 8 responders of an unspecified gender. The median age of subjects studied was 23 years, and the interquartile range was 23-24 years. The students at each university were chosen randomly by the author who worked there and had contact with them. An anonymous questionnaire was developed to gather information regarding demographics, the specialization which each student wanted to choose, the syncope occurrence in the medical history, the syncope and presyncope occurrence during surgery and autopsy as well as the syncopal events' characteristics. RESULTS: The group of 15% of women and 30% of men declared to have pursued the surgical specialization (P<0.001, 29% of women and 56% of men declared the intention to pursue an invasive specialization (P<0.001. As many as 36.0% of women studied and 13.1% of men studied reported syncopal spells outside university (P<0.001. Only 41 students (6.8% reported that syncope or presyncope in any studied circumstances had an impact on their specialization choice. The multivariate analysis showed that the choice of surgical specialization is related to the male gender and the absence of syncopal spells outside the university. CONCLUSIONS: Syncopal and presyncopal spells may affect the professional choices of the medical students. The male gender and a lack of syncope occurrence outside operating room are related to the choice of surgical specialization.

  4. Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing.

    Science.gov (United States)

    Giannopoulos, Georgios; Kossyvakis, Charalampos; Panagopoulou, Vasiliki; Tsiachris, Dimitrios; Doudoumis, Konstantinos; Mavri, Maria; Vrachatis, Dimitrios; Letsas, Konstantinos; Efremidis, Michael; Katsivas, Apostolos; Lekakis, John; Deftereos, Spyridon

    2017-05-01

    Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly. The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT). This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms. Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause). Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  5. Convulsive syncope related to a small dose of quetiapine in an adolescent with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Lai J

    2017-07-01

    Full Text Available Jianbo Lai,1,2 Qiaoqiao Lu,3 Tingting Huang,3 Shaohua Hu,1,2 Yi Xu1,2 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, 2Key Laboratory of Mental Disorder Management in Zhejiang Province, 3Department of Internal Medicine, Zhejiang University School of Medicine, Hangzhou, China Abstract: Quetiapine, an atypical antipsychotic, has been extensively used in patients with bipolar disorder. Overdose of quetiapine can result in severe complications, such as coma, seizure, respiratory depression, arrhythmia, and even death. However, the paucity of toxicological evaluation in adolescence causes more potential risks in this population. Herein, we present a case of hypotension and convulsive syncope after exposure to a small dose of quetiapine in a 16-year-old who was diagnosed with bipolar disorder. After cessation of quetiapine, no additional convulsive movements were reported. This case indicates that even in young patients without predisposing factors, close monitoring of adverse effects should be warranted for safety concerns, especially at the initiation of quetiapine treatment. Keywords: quetiapine, bipolar disorder, hypotension, convulsive syncope

  6. Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento).

    Science.gov (United States)

    Del Greco, Maurizio; Cozzio, Susanna; Scillieri, Marco; Caprari, Francesca; Scivales, Alessandro; Disertori, Marcello

    2003-02-01

    The ECSIT study was aimed at evaluating the hospital management of syncope patients, at comparing the appropriateness and costs of the hospital diagnostic pathway before (phase 1) and after (phase 2) the introduction of new guidelines and at analyzing the physicians' compliance to the guidelines. All syncope patients admitted to the emergency room between August 1 and October 31, 1999 (phase 1) and between March 1 and May 31, 2000 (phase 2) were enrolled and their clinical records were analyzed in a blind fashion. During the study 538 consecutive patients came to the emergency room for syncope with a hospitalization rate of 53% in phase 1 (n = 151) and of 42% in phase 2 (n = 107). The in-hospital stay increased from 9 days in phase 1 to 11.3 days in phase 2 and diagnostic tests from 2.6 per patient (phase 1) to 2.9 per patient (phase 2) with total costs that rose from [symbol: see text] 3,474 to [symbol: see text] 3,647. Patients with no diagnosis decreased from 51 to 45.8% and the principal causes were identified as vascular brain disease (36.1 vs 33.7%) and neurally-mediated mechanisms (35.3 vs 42.2%). Despite the high costs of syncope management, the appropriateness and efficacy of the hospital diagnostic pathway remains far from ideal and simply introducing new guidelines seems unable to modify clinical practice.

  7. Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

    Directory of Open Access Journals (Sweden)

    Samir Kanti Saha

    2013-01-01

    Full Text Available One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated following routine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitations and syncope. The patients were grouped into 3 different age categories: A 20-59 years of age (16%, B 60-69 years of age (26.4% and C > 70 years of age (57.6%. Heart rate profile, RR intervals, symptoms, frequency of premature supra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequency of premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the younger subjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24 hour occured incessantly throughout the registration. Patients with syncope and those without did not differ as regards the Holter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidence of syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation of syncope may not be the first hand mode of investigation in a non emergent setting. On the contrary, the modality appears to be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closer clinical follow up to prevent cardiac events and/or syncope leading to serious physical injury.

  8. Outreach syncope clinic managed by a nurse practitioner: Outcome and cost effectiveness.

    Science.gov (United States)

    Hamdan, Mohamed H; Walsh, Kathleen E; Brignole, Michele; Key, Jamie

    2017-01-01

    Introduction The purpose of this study was to assess the clinical and financial outcomes of a novel outreach syncope clinic. Methods We compared the clinical outcome of the Faint and Fall Clinic at the American Center (January-June 2016) with that of the University of Wisconsin Health and Clinics Faint and Fall Clinic (January 2013-December 2014). The American Center-Faint and Fall Clinic is run solely by a nurse practitioner, assisted by online faint-decision software and consultancy of a faint specialist through video-conferencing. Results Five hundred and twenty-eight consecutive patients were seen at the University of Wisconsin Hospital and Clinics-Faint and Fall Clinic and 68 patients at the American Center-Faint and Fall Clinic. The patients' clinical characteristics were similar except for a lower age in the American Center patients (45 ± 18 vs 51 ± 22, p = 0.03). Overall, a diagnosis was made within 45 days in 70% (95% confidence interval 66-74%) of the University of Wisconsin Hospital and Clinics patients and 69% (95% confidence interval 58-80%) of the American Center patients, ( p = 0.9). A mean of 3.0 ± 1.6 tests per patient was used in the University of Wisconsin Hospital and Clinics group compared to 1.5 ± 0.8 tests per patient in the American Center group, p = 0.001. Over the six-month study period, the total revenue at the American Center was US$152,597 (contribution margin of US$122,393 plus professional revenue of US$30,204). The total cost of the nurse practitioner including benefits was US$66,662 ((US$98,466 salary/year + 35.4% benefits)/2). Total revenue minus expenses resulted in a net profit of US$85,935. Discussion A nurse practitioner-run outreach syncope-clinic equipped with online faint-decision software and consultancy of a faint specialist through vedio-conferencing is feasible and financially self-sustainable. It allows the dissemination of standardized high-quality syncope care to patients who have

  9. [Variability of heart rhythm in dynamic study of the psychovegetative relationship in neurogenic syncope].

    Science.gov (United States)

    Musaeva, Z A; Khaspekova, N B; Veĭn, A M

    2001-01-01

    Physiological changes accompanying syncopes of neural origin (SNO) in patients with psychovegetative syndrome are still insufficiently studied. The data concerning the role of the autonomic nervous system are discrepant. Heart rate variability was analyzed in 68 patients with SNO in a supine position and during the active 20-min orthostatic test taking into account the heart rate components of very low frequency (VLF, an index of cerebral sympathetic activity) and high frequency (HF, a marker of vagal modulation). Steady growth of the VLF and progressive decrease in the LF within 15-20 min of the orthostasis were observed in all the patients (n = 33), who fainted after this period. The predominance of the VLF in the heart rate power spectra was correlated with a high level of anxiety. It is suggested that this fact indicates the stable cerebral sympathetic activation resulting in a baroreceptor dysfunction, i.e., a failure of vasomotor regulation in patients with SNO.

  10. Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

    OpenAIRE

    Casini, Alessandro; Tschanz, Elisabeth; Dietrich, Pierre-Yves; Nendaz, Mathieu

    2011-01-01

    Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus b...

  11. Syncope: causes, clinical evaluation, and current therapy.

    Science.gov (United States)

    Benditt, D G; Remole, S; Milstein, S; Bailin, S

    1992-01-01

    Syncope is a common clinical problem comprising the sudden loss of both consciousness and postural tone, with a subsequent spontaneous and relatively prompt recovery. Often it is difficult to differentiate a true syncopal spell from other conditions, such as seizure disorders, or from some simple accidents. Even more difficult is the identification of the cause of syncopal episodes. Nonetheless, establishing a definitive diagnosis ia an important task given the high risk of recurrent symptoms. Careful use of noninvasive and invasive cardiovascular studies (including electrophysiologic testing and tilt-table testing) along with selected hematologic, biochemical, and neurologic studies provides, in the majority of cases, the most effective strategy for obtaining a specific diagnosis and for directing therapy.

  12. Síndrome de Brugada en un paciente con síncope: Presentación de un caso y revisión de la literatura Brugada syndrome in a patient with syncope: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Carlos J Jaramillo

    2010-08-01

    Full Text Available El síndrome de Brugada es una enfermedad autosómica dominante esporádica que afecta los canales de sodio de los miocardiocitos. Clínicamente se caracteriza por síncopes recurrentes y/o muerte súbita, que en el electrocardiograma simula un bloqueo de rama derecha, acompañado de elevación peculiar del segmento ST en las derivaciones precordiales derechas (V1, V2 y V3 sin alteración cardiaca estructural. Afecta principalmente a hombres en la cuarta década de la vida y tiene mayor prevalencia en el suroeste asiático. El caso que se describe corresponde a un paciente con antecedentes personales de síncopes, a quien se le encuentra un patrón electrocardiográfico tipo-2 de Brugada y quien además tiene un hermano con historia de síncopes. Con una prueba de mesa basculantes positivo para síncope mediado neuralmente se deja este diagnóstico, pero no se descarta la sospecha inicial de síndrome de Brugada.Brugada syndrome is a sporadic autosomal dominant genetic disease that affects cardiac sodium channels. It is clinically characterized by recurrent syncope and/or sudden death with electrocardiographic manifestations that simulate a right bundle branch block accompanied by ST-segment elevation in the right precordial leads (V1, V2 and V3 without structural cardiac changes. It mainly affects men in their fourth decade and is most prevalent in southwestern Asia. We present the case of a patient with history of syncope, type-2 Brugada electrocardiographic pattern and who has a brother also with history of syncope. The patient had a positive tilt test for neurocardiogenic syncope. He was diagnosed as neurocardiogenic syndrome, without discarding the initial suspicion of Brugada syndrome.

  13. Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

    Directory of Open Access Journals (Sweden)

    Rossella Marino

    2013-10-01

    Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

  14. Manual compression and reflex syncope in native renal biopsy.

    Science.gov (United States)

    Takeuchi, Yoichi; Ojima, Yoshie; Kagaya, Saeko; Aoki, Satoshi; Nagasawa, Tasuku

    2018-03-14

    Complications associated with diagnostic native percutaneous renal biopsy (PRB) must be minimized. While life threatening major complications has been extensively investigated, there is little discussion regarding minor bleeding complications, such as a transient hypotension, which directly affect patients' quality of life. There is also little evidence supporting the need for conventional manual compression following PRB. Therefore, this study evaluated the relationship between minor and major complications incidence in patients following PRB with or without compression. This single-center, retrospective study included 456 patients (compression group: n = 71; observation group: n = 385). The compression group completed 15 min of manual compression and 4 h of subsequent strict bed rest with abdominal bandage. The observation group completed 2 h of strict bed rest only. The primary outcome of interest was transient symptomatic hypotension (minor event). Of the 456 patients, 26 patients encountered intraoperative and postoperative transient hypotension, which were considered reflex syncope without tachycardia. Univariate analysis showed that symptomatic transient hypotension was significantly associated with compression. This association remained significant, even after adjustment of covariates using multivariate logistic regression analysis (adjusted odds ratio 3.27; 95% confidential interval 1.36-7.82; P = 0.0078). Manual compression and abdominal bandage significantly increased the frequency of reflex syncope during native PRB. It is necessary to consider the potential benefit and risk of compression maneuvers for each patient undergoing this procedure.

  15. An episode of syncope attacks in adolescent schoolgirls: investigations, intervention and outcome.

    Science.gov (United States)

    Lee, P W; Leung, P W; Fung, A S; Low, L C; Tsang, M C; Leung, W C

    1996-09-01

    An increasing number of students in a secondary convent girls school developed syncope attacks over a time course of about two months. Fourteen students who suffered from syncope and 12 other students from the same class with no symptoms were assessed by a team of psychologists and paediatricians with the aim of identifying the cause of the problem and to formulate possible remedial action. Psychological assessments included a mental state examination, developmental, personal and psychological history, state-trait anxiety, self-esteem, hypnotic suggestibility, and students' beliefs about the cause and nature of the syncope attacks. Physical investigations included physical examination, blood pressure and electrocardiogram. The results indicated that most participants and controls had no physical or psychological pathologies. The two groups were not different on the physical and psychological measures. Analyses of the interview data, however, indicated that all the syncope sufferers belonged to a cohesive and exclusive social network. Social psychological circumstances rather than individual psychopathology were noted to be primarily responsible for the spread and maintenance of the mass hysterical influence. Intervention consisted of health education, authoritative reassurance and back-up support. Follow-up assessment after three and 12 months indicated no further syncope episodes.

  16. Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology.

    Science.gov (United States)

    Paris, Yvonne; Toro-Salazar, Olga H; Gauthier, Naomi S; Rotondo, Kathleen M; Arnold, Lucy; Hamershock, Rose; Saudek, David E; Fulton, David R; Renaud, Ashley; Alexander, Mark E

    2016-02-19

    Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs). Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5-year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise-related or more problematic symptoms. Guideline-defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow-up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach. SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low-severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  17. Alterations of brain network hubs in reflex syncope: Evidence from a graph theoretical analysis based on DTI.

    Science.gov (United States)

    Park, Bong Soo; Lee, Yoo Jin; Park, Jin-Han; Kim, Il Hwan; Park, Si Hyung; Lee, Ho-Joon; Park, Kang Min

    2018-06-01

    We evaluated global topology and organization of regional hubs in the brain networks and microstructural abnormalities in the white matter of patients with reflex syncope. Twenty patients with reflex syncope and thirty healthy subjects were recruited, and they underwent diffusion tensor imaging (DTI) scans. Graph theory was applied to obtain network measures based on extracted DTI data, using DSI Studio. We then investigated differences in the network measures between the patients with reflex syncope and the healthy subjects. We also analyzed microstructural abnormalities of white matter using tract-based spatial statistics analysis (TBSS). Measures of global topology were not different between patients with reflex syncope and healthy subjects. However, in reflex syncope patients, the strength measures of the right angular, left inferior frontal, left middle orbitofrontal, left superior medial frontal, and left middle temporal gyrus were lower than in healthy subjects. The betweenness centrality measures of the left middle orbitofrontal, left fusiform, and left lingual gyrus in patients were lower than those in healthy subjects. The PageRank centrality measures of the right angular, left middle orbitofrontal, and left superior medial frontal gyrus in patients were lower than those in healthy subjects. Regarding the analysis of the white matter microstructure, there were no differences in the fractional anisotropy and mean diffusivity values between the two groups. We have identified a reorganization of network hubs in the brain network of patients with reflex syncope. These alterations in brain network may play a role in the pathophysiologic mechanism underlying reflex syncope. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

  18. Angiotensin-converting enzyme gene polymorphism in arrhythmogenic right ventricular dysplasia: is DD genotype helpful in predicting syncope risk?

    Science.gov (United States)

    Ozben, Beste; Altun, Ibrahim; Sabri Hancer, Veysel; Bilge, Ahmet Kaya; Tanrikulu, Azra Meryem; Diz-Kucukkaya, Reyhan; Fak, Ali Serdar; Yilmaz, Ercument; Adalet, Kamil

    2008-12-01

    Arrhythmogenic right ventricular dysplasia (ARVD) is a heritable disorder characterised by fibrofatty replacement of right ventricular myocytes and increased risk of ventricular arrhythmias and sudden cardiac death. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism affects myocardial ACE levels. DD genotype favours myocardial fibrosis and is associated with malignant ventricular tachycardia. The aim of this study was to explore ACE gene polymorphism in ARVD patients. Twenty-nine patients with ARVD and 24 controls were included. All ARVD patients had documented sustained ventricular tachycardia. Thirteen patients had syncopal episodes. Six patients were resuscitated from sudden cardiac death. ACE gene polymorphism was identified by polymerase chain reaction technique. There was no significant difference in DD genotype frequency between ARVD patients and controls (44.8% vs. 45.8%, p=0.94). However, DD genotype frequency was significantly higher in ARVD patients with syncopal episodes compared to those without syncope (69.2% vs. 25.0%, p=0.017, odds ratio:6.750, 95% confidence interval: 1.318-34.565). DD genotype was detected in higher frequency also in patients with a family history of sudden cardiac death (66.7% vs. 39.1%,p=0.36). High prevalence of DD genotype in ARVD patients with syncope suggests that ACE I/D polymorphism might be useful in identifying high-risk patients for syncope.

  19. Ventricular Tachycardia Detected by Implantable Loop Recorder in a Child with Recurrent Syncope

    Directory of Open Access Journals (Sweden)

    İsa Özyılmaz

    2014-06-01

    Full Text Available In this article, we present a 10-year-old boy who was admitted to the hospital with recurrent syncope. There was no remarkable finding in patient’s physical examination, family history, and the diagnostic 12-lead electrocardiogram (ECG, chest x-ray, ECG Holter monitoring, event recording, echocardiography, coronary computed tomography (CT angiography, Ajmaline test for the diagnosis of Brugada syndrome, brain magnetic resonance imaging, and sleep/wake electroencephalogram. We started beta-blocker therapy because the patient had exercise-induced syncope. An Implantable loop recorder (ILR was inserted to the patient. Three years later, polymorphic ventricular tachycardia called torsades de pointes was detected by the ILR during syncope occurred with exercise. The patient had been taking high-dose betablocker treatment, an implantable cardioverter defibrillator was implanted into the patient. ILR can play an important role in the diagnosis of life-threatening arrhythmia in children with unexplained syncope. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 123-5

  20. [Neurohumoral mechanisms for vasovagal syncopes. Part I].

    Science.gov (United States)

    Gajek, Jacek; Zyśko, Dorota

    2003-04-01

    Vasovagal syncope is defined as a reflex loss of consciousness related to reaction to various stimuli as orthostatic stress, pain or emotions connected with loss of muscle postural tone. The aetiology of this disorder is still unknown. The imbalance between the parts of autonomic nervous system and other homeostasis-related systems as renin-angiotensin-aldosterone system, peptides as endothelin, neuropeptide Y, vasopressin, adrenomedullin and cAMP, adenosine and AMP can play an important role in the development of vasovagal syncope. In the first part of the paper the authors describe the mechanisms involved in the development of vasovagal reaction, pathophysiology of the head-up tilt test and the role of autonomic nervous system.

  1. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic

    Directory of Open Access Journals (Sweden)

    Baris Akdemir

    2015-03-01

    Full Text Available Syncope is among the most frequent forms of transient loss of consciousness (TLOC, and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i the patient's immediate (usually considered 1 week to 1 month mortality risk and risk for physical injury (e.g., falls risk, ii the patient's ability to care for him/herself, and iii whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation. However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

  2. Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient

    DEFF Research Database (Denmark)

    Clemmensen, Tor Skibsted; Mølgaard, Henning; Andersen, Niels Frost

    2016-01-01

    increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients' symptoms were...

  3. Diagnostic utility of carotid artery duplex ultrasonography in the evaluation of syncope: a good test ordered for the wrong reason.

    Science.gov (United States)

    Kadian-Dodov, Daniella; Papolos, Alexander; Olin, Jeffrey W

    2015-06-01

    Syncope refers to a transient loss of consciousness and postural tone secondary to cerebral hypoperfusion. Guidelines recommend against neurovascular testing in cases of syncope without neurologic symptoms; however, many pursue carotid artery duplex ultrasonography (CUS) due to the prognostic implications of identified cerebrovascular disease. Our objective was to determine the diagnostic utility of CUS in the evaluation of syncope and the identification of new or severe atherosclerosis with the potential to change patient management. We reviewed records of 569 patients with CUS ordered for the primary indication of syncope through an accredited vascular laboratory at an academic, urban medical centre. Findings on CUS, patient demographic, clinical and laboratory information, and medications within 6 months of the CUS exam were reviewed. Bivariate relationships between key medical history characteristics and atherosclerosis status (known vs. new disease) were examined. Among 495 patients with complete information, cerebrovascular findings could potentially explain syncope in 2% (10 patients). Optimization of cardiovascular risk factors would benefit patients with known (56.6%) and new atherosclerosis (33.5%) with suboptimal lipid control, (LDL > 70 in 42.2 and 34.9% respectively; LDL > 100 in 15.7 and 20.4%), and those not on high-intensity statin therapy (80 and 87.5%) or antiplatelet medications (13.2 and 50.6%). CUS is a low-yield diagnostic test in the evaluation of syncope, but it is useful in the diagnosis of atherosclerosis and identification of subjects who would benefit from optimal medical therapy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  4. Hyperventilation, cerebral perfusion, and syncope

    DEFF Research Database (Denmark)

    Immink, R V; Pott, F C; Secher, N H

    2014-01-01

    dioxide (PaCO2) and oxygen (PaO2) partial pressures so that hypercapnia/hypoxia increases and hypocapnia/hyperoxia reduces global cerebral blood flow. Cerebral hypoperfusion and TLOC have been associated with hypocapnia related to HV. Notwithstanding pronounced cerebrovascular effects of PaCO2...... the contribution of a low PaCO2 to the early postural reduction in middle cerebral artery blood velocity is transient. HV together with postural stress does not reduce cerebral perfusion to such an extent that TLOC develops. However when HV is combined with cardiovascular stressors like cold immersion or reduced...... cardiac output brain perfusion becomes jeopardized. Whether, in patients with cardiovascular disease and/or defect, cerebral blood flow cerebral control HV-induced hypocapnia elicits cerebral hypoperfusion, leading to TLOC, remains to be established....

  5. 77-year-old female with syncope.

    Science.gov (United States)

    Abdelsalam, Mahmoud A; Geske, Jeffrey B

    2017-02-15

    A 77-year-old female was referred for evaluation of an episode of syncope while eating breakfast. There was no history of fall, syncope, prodrome, dyspnoea, chest discomfort or palpitations. Medical history was notable for hyperlipidaemia and treated hypertension. Blood pressure was 140/90 mm Hg, pulse 85  beats per minute (BPM). No murmurs were present on cardiac examination. ECG revealed normal sinus rhythm with left ventricular (LV) hypertrophy (see online supplementary figure S1). Holter monitor demonstrated rare premature ventricular complexes (<1% of beats), without heart block or ventricular tachycardia. Transthoracic echocardiogram is shown in figure 1. Which of the following is the explanation for the flow indicated by the yellow arrow? Aortic stenosisCoronary artery flow, indicative of coronary fistulaHypertrophic cardiomyopathy with apical pouchHypertensive heart diseaseMitral stenosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Parent and Child Psychological Factors in Pediatric Syncope and Other Somatic Symptoms

    Science.gov (United States)

    Blount, Ronald L.; Morris, Julie A. B.; Cheng, Patricia S.; Campbell, Robert M.; Brown, Ronald T.

    2004-01-01

    The authors examined associations among parental and child adjustment, child syncope, somatic, and school problems. Participants were children (N = 56) ages 7-18 years with syncope. Measures included syncope severity, parental distress, and children's internalizing symptoms. For children diagnosed negative for neurocardiogenic syncope (NCS), their…

  7. Presentation of a glomus carotid tumor as carotid sinus syndrome with syncopal episodes

    International Nuclear Information System (INIS)

    Dickschas, A.; Harmann, B.; Herzog, T.; Marienhagen, J.

    1987-01-01

    An 80 year old patient was referred to neurology for clarification of her episodes of syncope. A set of radiological examinations indicated a diagnosis of paraganglion of the left carotid bifurcation. Using this case, an attempt is made to provide recommendations concerning the order of step-wise visualization techniques of clarifying glomus carotid tumors. This unusual case also provides an impetus for considering the physiology and pathogenesis of different forms of carotid sinus syndrome. (orig.) [de

  8. Fainting during Urination (Micturition Syncope): What Causes It?

    Science.gov (United States)

    ... causes this, and what can he do about it? Answers from Phillip A. Low, M.D. Micturition ( ... of micturition syncope isn't fully understood. But it may be related to opening (vasodilation) of the ...

  9. Syncopation affects free body-movement in musical groove

    DEFF Research Database (Denmark)

    Witek, Maria A. G.; Popescu, Tudor; Clarke, Eric F

    2016-01-01

    One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measur...... on the body-part. We demonstrate that while people do not move or synchronise much to rhythms with high syncopation when dancing spontaneously to music, the relationship between rhythmic complexity and synchronisation is less linear than in simple finger-tapping studies.......One of the most immediate and overt ways in which people respond to music is by moving their bodies to the beat. However, the extent to which the rhythmic complexity of groove-specifically its syncopation-contributes to how people spontaneously move to music is largely unexplored. Here, we measured...... free movements in hand and torso while participants listened to drum-breaks with various degrees of syncopation. We found that drum-breaks with medium degrees of syncopation were associated with the same amount of acceleration and synchronisation as low degrees of syncopation. Participants who enjoyed...

  10. Case report of precursor B-cell lymphoblastic lymphoma presenting as syncope and cardiac mass in a nonimmunocompromised child.

    Science.gov (United States)

    Hahn, Barry; Rao, Sudha; Shah, Binita

    2007-08-01

    We report the case of a previously healthy, 10-year-old boy who presented to the emergency department with a syncopal episode. In the emergency department, the patient was diagnosed with a right atrial mass, later identified as a precursor B-cell lymphoblastic lymphoma (LL). Most causes of syncope in children are not life threatening. In most cases, it indicates a predisposition to vasovagal episodes. Lymphomas account for approximately 7% of malignancies among children younger than 20 years, are more common in white males and immunocompromised patients, and are predominantly tumors of T-cell origin. Children with non-Hodgkin lymphoma usually present with extranodal disease, most frequently involving the abdomen (31%), mediastinum (26%), or head and neck (29%). Our patient was unique in that he was a nonimmunocompromised, black boy, presenting with syncope in the setting of a large atrial mass identified as a precursor B-cell LL. To our knowledge, there are no reported cases of precursor B-cell LL presenting as syncope and a cardiac mass.

  11. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  12. Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy.

    Science.gov (United States)

    Mayuga, Kenneth A; Ho, Natalie; Shields, Robert W; Cremer, Paul; Rodriguez, L Leonardo

    2018-01-01

    A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

  13. Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

    Directory of Open Access Journals (Sweden)

    Kenneth A. Mayuga

    2018-01-01

    Full Text Available A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

  14. Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2016-01-01

    Full Text Available We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT. We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis.

  15. Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box

    Directory of Open Access Journals (Sweden)

    Thein Aung

    2013-07-01

    Full Text Available The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.

  16. Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box.

    Science.gov (United States)

    Aung, Thein; Fan, Wuqiang; Krishnamurthy, Mahesh

    2013-01-01

    The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED) stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.

  17. Bleeding from ruptured hepatic metastases as a cause of syncope in an octogenarian: a case report

    Directory of Open Access Journals (Sweden)

    Rizeq Mazen M

    2010-06-01

    Full Text Available Abstract Introduction Acute hemoperitoneum as a result of hemorrhage from liver metastases is an uncommon but serious condition. The use of appropriate imaging is important in the diagnosis and can have a profound impact on subsequent management. This case is important because the presentation was of recurrent syncopal episodes with an unusual underlying cause. This case highlights the need to consider this diagnosis in the differential in patients presenting with collapse in the acute setting. Case presentation We present the case of an 85-year-old Caucasian man who was admitted following a collapse episode and was found to be persistently hypotensive despite aggressive resuscitation. An acute intra-peritoneal bleed originating from hepatic metastases from an unknown primary was identified promptly with computed tomography imaging and was subsequently managed conservatively. Conclusions This case aims to convey key teaching points: (A the need to consider intra-abdominal hemorrhage in the differential diagnosis when assessing patients with collapse; and (B the use of appropriate imaging such as computed tomography can facilitate a prompt diagnosis and appropriate management steps can then be taken accordingly.

  18. Craniocervical Junction Meningiomas without Hydrocephalus Presenting Solely with Syncope: Report of 2 Cases.

    Science.gov (United States)

    Champagne, Pierre-Olivier; Bojanowski, Michel W

    2018-06-01

    To our knowledge, there have not been any reported cases of a meningioma of the craniocervical region presenting solely with syncope as its initial symptom. Only 1 case of meningioma presenting with syncope has been published, but it was associated with hydrocephalus. We report 2 cases of syncope caused by a craniocervical junction meningioma, with syncope being the sole presenting symptom and without hydrocephalus. We discuss the possible pathophysiology, as well as the clinical relevance of this type of presentation. We reviewed the charts, operative details, and imagery of 2 cases of meningioma in the region of the craniocervical junction, with syncope as their sole presenting feature. We also reviewed the literature. In 1 case the syncope occurred spontaneously. In the other, it occurred during a Valsalva maneuver. Both meningiomas were surgically removed via a retromastoid approach. There was no recurrence of syncope following surgery. Following a literature review, we found 1 case of posterior fossa meningioma presenting with syncope, but hydrocephalus was also present. Syncope can be the sole manifestation of a meningioma of the craniocervical junction. Such syncopes are a consequence of transient dysfunction of the autonomous pathways in the medulla and/or of the medulla's output. In the absence of other causes of syncope, a meningioma in this region, even in the absence of hydrocephalus, should not be considered as fortuitous, but rather as the actual cause of syncope. Recognizing this possibility offers the potential for proper diagnosis and appropriate treatment of the syncope. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Clinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST-MI 2010 registry.

    Science.gov (United States)

    Puymirat, Etienne; Aissaoui, Nadia; Bonello, Laurent; Cayla, Guillaume; Labèque, Jean-Noel; Nallet, Olivier; Motreff, Pascal; Varenne, Olivier; Schiele, François; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

    2017-12-01

    Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis. Long-term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients. FAST-MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation. Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69-1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00-5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18-2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31-2.10, P clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long-term mortality in STEMI and NSTEMI populations. © 2017 Wiley Periodicals, Inc.

  20. Syncope as the Presenting Feature of Splenic Rupture after Colonoscopy

    Directory of Open Access Journals (Sweden)

    Daniel Jamorabo

    2014-01-01

    Full Text Available Splenic rupture is a rare, catastrophic complication of colonoscopy and an exceptional cause of syncope. This injury is believed to be from direct trauma or tension on the splenocolic ligament with subsequent capsule avulsion or else from direct instrument-induced splenic injury. Diagnosis requires a high index of suspicion that may be absent because presentation can be subtle, nonspecific, and delayed anywhere from hours to days and therefore not easily attributed to a recent endoscopy. We describe a case of syncope as the initial manifestation of splenic rupture after colonoscopy. Our patient’s pain was delayed; his discomfort was mild and not localized to the left upper quadrant. Clinicians should consider syncope, lightheadedness, and drop in hemoglobin in absence of rectal bleeding following a colonoscopy as possible warning signs of imminent or emergent splenic injury.

  1. Management of Wolff-Parkinson-White Tachyarrhythmia Presenting as Syncope with Seizure-like Activity

    Directory of Open Access Journals (Sweden)

    Samuel Kaplan

    2017-09-01

    Full Text Available Audience: Emergency Medicine residents and medical students. Introduction: An estimated 3% of the United States population suffers from recurrent convulsive episodes that are most often attributed to primary epileptic seizures.1 However, recent studies have estimated about 20%-30% of such episodes are associated with occult cardiac etiology,2 which carry one-year mortality rates of up to 30%.3 Cardiogenic cerebral hypoxia has been associated with a wide variety of neurologic disturbances, including dizzy spells, headache, syncope, focal motor deficit, generalized tonic-clonic seizure, confusion, dementia, and psychosis.4 Convulsive activity has tentatively been ascribed to the ensuing activation of the medullary reticular formation.5,6 This scenario is based on a patient that presented to University of California Irvine Medical Center Emergency Department in April 2017 who, following witnessed seizure-like episodes, was diagnosed with underlying Wolff-Parkinson-White (WPW disorder. WPW is a congenital condition involving aberrantly conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit and ventricular pre-excitation.7 Diagnosis is primarily based on the presence of a short PR interval and delta waves on electrocardiography.8 While definitive treatment is catheter-based radiofrequency ablation of the accessory pathway, the hallmark of acute management is vagal maneuvers and antiarrhythmic drugs in the symptomatic but hemodynamically stable patient, and synchronized cardioversion in the unstable patient.9 WPW is thought to affect between 0.1% and 0.3% of the population, and while the usual clinical course is benign, sudden cardiac death occurs in about 3%-4% of such patients.7,10 One survey found 19% of patients with WPW had a history of syncopal episodes;11 however, precise prevalence surveys of WPW-associated seizure-like episodes are lacking in the current literature. This case

  2. Oral Pirfenidone in patients with chronic fibrosis resulting from radiotherapy: a pilot study

    International Nuclear Information System (INIS)

    Simone, Nicole L; Soule, Benjamin P; Gerber, Lynn; Augustine, Elizabeth; Smith, Sharon; Altemus, Rosemary M; Mitchell, James B; Camphausen, Kevin A

    2007-01-01

    Fibrosis is a common side effect after treatment with ionizing radiation. Several methods to ameliorate debilitating fibrosis have been employed but without consistent results. The goal of this pilot study is to determine if Pirfenidone, a novel regulator of cytokine gene expression, has the potential to ameliorate established radiation-induced fibrosis. Open label, prospective pilot study of 800 mg three times/day, orally administered Pirfenidone was administered to enrolled patients who were had completed radiation therapy and who had established radiation-induced fibrosis. Range of motion (ROM) was assessed using standard measures, and subjective measures of pain, fatigue, disability and global health were measured every three months. Seven patients were enrolled of whom 3 had ROM assessments of 1 site and 2 had ROM assessments of 2 sites. Of these assessments, 6 revealed increased ROM during drug intervention while 1 revealed a decreased ROM. There was an overall improvement in the mental composite score of the SF36 while physical composite score was decreased and the vitality score was unchanged. Two patients were removed from the study because of syncopal episodes. Several patients experienced improved function of at least 25% and reported subjective improvement. Pirfenidone may benefit patients with radiation-induced fibrosis and is worthy of a larger well controlled trial

  3. NMR - finding in a case of Morquio's syndrome with syncope

    International Nuclear Information System (INIS)

    Treig, T.; Huk, W.; Nusslein, B.

    1987-01-01

    Acute or chronic cervical myelopathies are well known neurological complications of mucopolysaccharidoses This paper deals with a case of a mild form of Morquio's disease which appeared with syncope. NMR-imaging of the cranio-spinal region demonstrated a high intensity echo in the medulla oblongata before and after spinal decompression

  4. Corpus-Based Rhythmic Pattern Analysis of Ragtime Syncopation

    NARCIS (Netherlands)

    Koops, Hendrik Vincent; Volk, A.; de Haas, W.B.

    2015-01-01

    This paper presents a corpus-based study on rhythmic patterns in the RAG-collection of approximately 11.000 symbolically encoded ragtime pieces. While characteristic musical features that define ragtime as a genre have been debated since its inception, musicologists argue that specific syncopation

  5. Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

    Science.gov (United States)

    Tomson, Todd T; Passman, Rod

    Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.

  6. Sincope en la infancia y adolescencia Syncope in infants and adolescents

    Directory of Open Access Journals (Sweden)

    Sergio A. Antoniuk

    2007-01-01

    precoz.Aim: To review the syncope in infants and adolescents as well as its etiology, clinical manifestations, physiopathology, diagnostic methods and treatment. Development: The syncope is a clinical entity characterized by sudden and transient loss of consciousness and postural tone, with a quick and complete recovery. The syncope is frequent in children and adolescents. The most common cause is neurocardiogenic (vasovagal, which has a benign evolution. Other causes may be neurological, cardiac and metabolic diseases, with a variable prognosis, which may come to be severe and potentially lethal. Evaluation of the syncope is mainly based on present clinical history, and on a detailed clinical examination. Basic complementary exams may help on the diagnosis, as a glycemia test, determination of electrolytes (sodium, potassium, magnesium, a hemogram and an electrocardiogram. The Tilt Test is "the" test to confirm the neurocardiogenic syncope. Treatment is indicated in syncopes with recurrent episodes or with risk of physical lesions. Prevention and education are indicated for all patients. Specific treatment should be individually given to each patient. In the case of neurocardiogenic syncope, beta-blockers, alpha-adrenergic stimulants, serotonin reuptake inhibitors, and fludrocortisone are used. In the frequently recurrent neurocardiogenic syncope, when preventive actions are not enough or there is risk of lesions in consequence of falls, beta-blockers, alpha-adrenergic stimulants, serotonin reuptake inhibitors, and fludrocortisone are used, as well as a pacemaker for severe cases non-responsive to pharmacological treatment. Conclusion: The syncope is a frequent clinical entity in infancy and adolescence, with benign evolution but potentially lethal. Diagnosis and correct etiology are important for the implementation of specific and early treatment.

  7. Solitary fibrous tumor of the pleura presenting with syncope episodes when coughing

    Directory of Open Access Journals (Sweden)

    Ciulla Michele M

    2008-08-01

    Full Text Available Abstract Background Solitary fibrous tumor of the pleura is a rarely encountered clinical entity which may have different clinical pictures. Although the majority of these neoplasms have a benign course, the malignant form has also been reported. Case presentation We herein describe a case of 72 year-old man with head, facial, and thoracic traumas caused by neurally-mediated situational syncope when coughing. The diagnostic work-up including chest x-ray, CT and PET, revealed a large solitary mass of the left hemithorax. Radical surgical resection of the mass was performed through a left lateral thoracotomy and completed with a wedge resection of the lingula. Hystological examination of the surgical specimen showed an encapsulated mass measuring 12 × 11.5 × 6 cm consistent with a solitary fibrous tumor of the pleura. It's surgical removal definitively resolved the neurologic manifestations. The patient had no postoperative complications. At two years follow-up the patient is free from recurrence and without clinical manifestations. Conclusion In our case its resection definitively resolved the episodes of situational syncope due, in our opinion, to the large thoracic mass compressing the phrenic nerve

  8. Síncope inducido por el ejercicio: Reporte de un caso Exercise-induced syncope: case report

    Directory of Open Access Journals (Sweden)

    Andrés Alvarado

    2011-04-01

    Full Text Available El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.Exercise-induced syncope is a condition that should alert the treating physician; structural cardiac abnormalities that predispose to sudden death should be discarded, and the presence of arrhythmias that may potentially cause this condition are evaluated. In patients over 35 years, coronary and valvular disease are ruled-out as a possible cause of syncope associated with exercise. In subjects who train frequently, increased vagal tone is a common adaptive condition that may sometimes cause cardio-inhibitory syncope associated with exercise, whose presentation may vary from bradyarrhythmia to asystolia, thereby providing a diagnostic challenge.

  9. Epileptic Seizures Versus Syncope: Pathophysiology and Clinical Approach

    Directory of Open Access Journals (Sweden)

    Marios Charalambous

    2017-02-01

    Full Text Available Generalised epileptic seizures and syncope are two syndromes with similar clinical manifestation and their differentiation can be quite challenging. The aim of this review is to use an evidence-based approach in differentiating these two syndromes through the comprehension of the pathophysiological mechanisms involved and their clinical signs. Both syndromes affect regions of the forebrain and consciousness level, although, different mechanisms are involved. Syncope is a paroxysmal event secondary to a short-term decrease in cerebral perfusion, oxygenation or essential nutrients delivery. Generalised epileptic seizure activity is defined as the clinical manifestation of transient paroxysmal disturbances in brain function secondary to an imbalance between excitatory and inhibitory neurotransmitters. Clinical criteria, including precipitating events, clinical signs preceding, during and following the episodes and event duration, can be used to differentiate the two syndromes. Although these criteria might be useful for the practitioner, definite conclusions should be precluded due to the lack of original research articles and weak evidence on this specific field.Application: The review might be a useful tool for the general practitioner and clinical scientist as it will aid towards the differentiation of two syndromes, i.e. generalised epileptic seizures and syncope, with similar clinical presentation.

  10. The risk for syncope and presyncope during surgery in surgeons and nurses.

    Science.gov (United States)

    Rudnicki, Jerzy; Zyśko, Dorota; Gajek, Jacek; Kuliczkowski, Wiktor; Rosińczuk-Tonderys, Joanna; Zielińska, Dominika; Terpiłowski, Łukasz; Agrawal, Anil Kumar

    2011-11-01

    Surgeons and nurses are exposed to orthostatic stress. To assess the lifetime incidence of syncopal and presyncopal events during surgery in operation room staff and reveal the predicting factors. The study included 317 subjects (161 F, 156 M) aged 43.9 ± 9.6; 216 surgeons and 101 instrumenters. The study included filling of an anonymous questionnaire on the syncope and presyncope history. At least one syncopal event during operation was reported by 4.7% and presyncope by 14.8% of the studied population. All but one subject reported prodromal symptoms before syncope. In the medical history, syncope outside the operating room was reported by 11% of the studied group. Syncope and presyncope during operation was related to syncope in the medical history outside the operation room, respectively: odds ratio (OR) 20.2 95% confidence interval (CI): 2.0-70.5 and OR 10.8; CI: 5.0-23.4 and to presyncope in the medical history, respectively: OR 23.5; CI: 7.4-74.4 OR 8.9; CI: 3.6-11.2 (P < 0.001). (1) Syncope and presyncope may occur during surgery in the staff of the operating room. (2) Syncope in the operating room is usually preceded by prodromal symptoms and has vasovagal origin. (3) Both lower then expected occurrence of syncope in the operating room staff and absence of any difference between genders in this regard indicate preselection in the process of choosing profession and specialization. (4) Syncope and presyncope outside the operating room in medical history increases the risk of syncope and presyncope inside the operation room.

  11. A new hypothesis of cause of syncope: trigeminocardiac reflex during extraction of teeth.

    Science.gov (United States)

    Arakeri, Gururaj; Arali, Veena

    2010-02-01

    Transient Loss Of Consciousness (TLOC) or vasovagal syncope is well known phenomenon in dental/maxillofacial surgery. Despite considerable study of vasovagal syncope, its pathophysiology remains to be fully elucidated. After having encountered a case of trigeminocardiac reflex after extraction of maxillary first molar we observed and studied 400 extractions under local anesthesia to know the relation between trigeminocardiac reflex and syncope. We make hypothesis that trigeminocardiac reflex which is usually seen under general anesthesia when all sympathetic reflexes are blunted can also occur under local anesthesia during extractions of maxillary molars (dento-cardiac reflex) and mediate syncope.

  12. The egsys and oesil risk scores for classification of cardiac etiology of syncope: comparison, revaluation, and clinical Implications

    Czech Academy of Sciences Publication Activity Database

    Plášek, J.; Doupal, V.; Fürstová, Jana; Martínek, A.

    2010-01-01

    Roč. 154, č. 2 (2010), s. 169-173 ISSN 1213-8118 Institutional research plan: CEZ:AV0Z10300504 Keywords : Syncope * Cardiac Syncope * EGSYS * OESIL * Emergency Department * Decision - Making * Syncope Management Unit Subject RIV: IN - Informatics, Computer Science Impact factor: 0.716, year: 2010

  13. Syncope During Competitive Events: Interrogating Heart Rate Monitor Watches May Be Useful!

    Science.gov (United States)

    Thabouillot, Oscar; Bostanci, Kevin; Bouvier, Francois; Dumitrescu, Nicolae; Stéfuriac, Maria; Paule, Philippe; Roche, Nicolas-Charles

    2017-12-01

    This is a case report of a 45-year-old man who reported complete amnesia during the very first kilometer of a 10-km run. He was wearing a heart rate monitor (HRM). The interrogation of his HRM watch showed 200 bpm tachycardia beginning in the first kilometer and increasing up to 220 bpm during the last kilometer. The patient was asked to wear a Holter-monitor (Holter Research Laboratory; Helena, Montana USA) electrocardiogram (ECG) while practicing a training session. This examination allowed for the diagnosis of an adrenergic paroxysmal atrial fibrillation (AF) with an impressive auriculo-ventricular conduction over 260 bpm. This case highlights that non-medical devices, such as connected watches, can be helpful to diagnose arrhythmias. Thabouillot O , Bostanci K , Bouvier F , Dumitrescu N , Stéfuriac M , Paule P , Roche NC . Syncope during competitive events: interrogating heart rate monitor watches may be useful! Prehosp Disaster Med. 2017;32(6):691-693.

  14. Results after gastrocnemius recession in 73 patients.

    Science.gov (United States)

    Molund, Marius; Paulsrud, Øyvind; Ellingsen Husebye, Elisabeth; Nilsen, Fredrik; Hvaal, Kjetil

    2014-12-01

    Very few studies describe the clinical results and complications following the surgical procedure of gastrocnemius recession. To survey the patient reported outcomes in patients operated with gastrocnemius recession as single procedure for various foot conditions. 93 patients operated with gastrocnemius recession as single procedure between 2006 and 2011 were detected in the database. 73 patients responded to the invitation for study participation. Questionnaires containing patient reported satisfaction, complications, plantar flexion power and visual analog pain score were used for evaluation of the postoperative result. 45/73 (62%) patients reported a good or excellent result. 8/73 (11%) patients reported a significant postoperative complication. 16/73 (22%) patients noted reduced or severely reduced plantar flexion power after surgery. VAS pain score significantly decreased from 7.0 before surgery to 1.8 (p=0.015) after surgery for patients with plantar fasciitis (n=18) and from 5.6 to 2.3 (p<0.01) for patients with metatarsalgia (n=28). Patients treated with gastrocnemius recession for plantar fasciitis demonstrated good clinical results. The complication rate was higher than reported by others. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  15. Vasovagal syncope in medical students and their first-degree relatives.

    Science.gov (United States)

    Serletis, Anna; Rose, Sarah; Sheldon, Aaron G; Sheldon, Robert S

    2006-08-01

    To determine the effect of family history on the likelihood of vasovagal syncope. Sixty-two medical students and 228 first-degree relatives were studied. Vasovagal syncope was ascertained with the Calgary syncope symptom score. The effects of the sex of the subject and parental syncope history on the likelihood of offspring fainting were described using Kaplan-Meier estimates and analysed using proportional hazards regression. The prevalence of vasovagal syncope was 32% and the median age of first faint in those who fainted was 14 years. More females than males fainted [42 vs. 31%; P=0.02; hazard ratio (HR) 1.34 (95% CI 1.07-1.68)]. An individual with two fainting parents was more likely to faint than one with no fainting parents [P<0.0001; HR 3.4 (95% CI 1.7-7.03)]. In the proportional hazards model, offspring of either sex whose mother faints are more likely to faint than those whose mother does not faint [HR 2.86 (95% CI 1.54-5.31)]. Having a father who faints significantly increases the risk of syncope in sons [HR 4.12 (95%CI 1.39-12.31)], but not in daughters [HR 1.18 (95% CI 0.56-3.34)]. Family history and sex of subject are important predictors of vasovagal syncope in offspring.

  16. Mechanisms of lower body negative pressure-induced syncope

    Science.gov (United States)

    Davrath, Linda Ruble

    Although extensively investigated, the mechanisms of post-spaceflight orthostatic intolerance have not been elucidated. The working hypothesis was that a markedly reduced left ventricular end-systolic volume (LVESV) would be achieved during progressive, presyncopal-limited LBNP and would cause bradycardia and a fall in blood pressure, thus triggering syncope. Eight healthy men, age 25.1 ± 1.3 years, volunteered for the study. Subjects were exposed to graded levels of LBNP on two separate occasions. Changes in left ventricular end-diastolic volume and LVESV were measured, using two-dimensional echocardiography, at each stage of LBNP from rest to presyncope. Plasma venous blood samples were withdrawn at the end of each stage of the LBNP protocol for the measurement of plasma venous catecholamines and plasma renin activity (PRA). Catecholamines were analyzed by HPLC with electro-chemical detection, and PRA was determined by radioimmunoassay. All subjects reached presyncope during the LBNP. LVESV decreased by 28% at presyncope with no evidence of ventricular cavity obliteration. Norepinephrine (NE) increased by 44% from rest to presyncope, but no epinephrine surge was detected (35% increase from rest to presyncope). These data indicate that it is possible to initiate syncope with only a 28% decrease in LVESV, and that sympatho-inhibition and bradycardia are not required elements for syncope to occur. To investigate the effect of moderate sodium restriction on cardiovascular hemodynamics and orthostatic tolerance, presyncopal LBNP testing was performed. Urinary sodium excretion was significantly higher on the normal-sodium diet when compared with the sodium-restricted diet, but urinary potassium was not different. Cumulative stress index (655 ± 460 on normal-sodium diet vs. 639 ± 388 on sodium-restricted diet) scores were not different. Cardiac volumes, blood pressure and total peripheral resistance were not different at any stage of the LBNP between the diets, nor

  17. Association Between Baseline Blood Pressures, Heart Rates, and Vasovagal Syncope in Children and Adolescents.

    Science.gov (United States)

    Adlakha, Himanshu; Gupta, Ruchi; Hassan, Romana; Kern, Jeffrey H

    2018-01-28

    Vasovagal syncope is the most common cause of syncope in children and adults, accounting for 50-66% of unexplained syncope. There are no studies establishing the relationship between syncope, baseline heart rate, and blood pressure. To identify a possible association between baseline blood pressure and heart rate with syncope. We conducted a questionnaire-based chart review study. A questionnaire was distributed to the guardian of children between eight and 18 years of age who attended the Pediatric Ambulatory Care Clinic at Flushing Hospital Medical Center. Based on the responses in the questionnaire, subjects were classified either as cases (positive for syncope) or controls (negative for syncope). Children and adolescents with neurological, cardiac, or any medical condition that can cause syncopal episodes were excluded from the study. Data collected from the questionnaire included age, gender, ethnicity, medical history, family history of syncope, and the amount of salt used in food. Anthropometric and vital signs for the current visit (height, weight, BMI, blood pressure, and heart rate) and vital signs from two previous visits were collected from electronic medical records. The data was analyzed using t-test and chi-square test with Microsoft Excel software (Microsoft Office Standard, v. 14, Microsoft; 2010); p<0.05 was considered significant. A total of 197 subjects were included in this study. There were 18 cases and 179 controls. Of the cases, (4/18) 22.2% were more likely to have a systolic blood pressure lower than the 10th percentile for their gender, age, and height as compared with controls (7/179) 3.9%, p = 0.003. The subjects with a history of syncope were more likely to add salt to their food (p = 0.004). There were no significant differences between cases and controls for age, gender, ethnicity between cases and controls for systolic blood pressure. No significant difference was observed between the heart rates of cases and controls. Children

  18. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope.

    Science.gov (United States)

    Doğan, Ebru Apaydın; Ünal, Ali; Ünal, Aslıhan; Erdoğan, Çağla

    2017-10-01

    The differential diagnosis of generalized tonic-clonic seizures (GTCS), psychogenic nonepileptic seizures (PNES), and syncope constitutes a major challenge. Misdiagnosis rates up to 20 to 30% are reported in the literature. To assess the clinical utility of serum lactate levels for differentiation of GTCS, PNES, and syncope based on gender differences. Data from 270 patients were evaluated retrospectively. Only patients ≥18 years old with the final diagnosis of GTCS, PNES, or syncope in their chart were recruited. Serum lactate levels were measured in the first 2h of the index event. Serum lactate levels in patients with GTCS (n=157) were significantly higher than in the patients with PNES (n=25) (plactate levels in patients with GTCS were significantly higher in the male subgroup (p=0.004). In male patients the ROC analysis yielded a serum lactate value of 2.43mmol/l with a sensitivity of 0.85 and a specificity of 0.88 as the optimal cut-off value to distinguish GTCS from other events. The ROC analysis for the AUC yielded a high estimate of 0.94 (95% confidence interval: 0.91-0.98). When a cut-off value of 2.43mmol/l was chosen for the females, which was an optimal value for male patients, the specificity was 0.85, however, the sensitivity was 0.64. We propose that serum lactate level when measured in the first 2h after the index event has a high clinical utility in the differential diagnosis of GTCS, PNES, and syncope. With concomitant clinical signs and physical examination findings besides neuroimaging and EEG, elevated levels of lactate should be taken into account when evaluating a patient with impaired consciousness. On the other hand, the suggested cut-off value 2.43mmol/l might not have a discriminative effect between GTCS, PNES, and syncope in female patients. This finding should be verified in a prospectively designed study with a larger patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Risk of malignant arrhythmias in initially symptomatic patients with Wolff-Parkinson-White syndrome: results of a prospective long-term electrophysiological follow-up study.

    Science.gov (United States)

    Pappone, Carlo; Vicedomini, Gabriele; Manguso, Francesco; Baldi, Mario; Pappone, Alessia; Petretta, Andrea; Vitale, Raffaele; Saviano, Massimo; Ciaccio, Cristiano; Giannelli, Luigi; Calovic, Zarko; Tavazzi, Luigi; Santinelli, Vincenzo

    2012-02-07

    The available amount of detailed long-term data in patients with Wolff-Parkinson-White syndrome is limited, and no prospective electrophysiological studies looking at predictors of malignant arrhythmia are available. Among 8575 symptomatic Wolff-Parkinson-White patients with atrioventricular reentrant tachycardia referred for electrophysiological test, 369 (mean age, 23±12.5 years) declined catheter ablation and were followed up. The primary end point of the study was to evaluate over a 5-year follow-up the predictors and characteristics of patients who develop malignant arrhythmias. After a mean follow-up of 42.1±10 months, malignant arrhythmias developed in 29 patients (mean age, 13.9±5.6 years; 26 male), resulting in presyncope/syncope (25 patients), hemodynamic collapse (3 patients), or cardiac arrest caused by ventricular fibrillation (1 patient). Of the remaining 340 patients, 168 (mean age, 34.2±9.0 years) remained asymptomatic up to 5 years, and 172 (mean age, 13.6±5.1 years) had benign recurrence, including sustained atrioventricular reentrant tachycardia (132 patients) or atrial fibrillation (40 patients). Compared with the group with no malignant arrhythmias, the group with malignant arrhythmias showed shorter accessory-pathway effective refractory period (PWolff-Parkinson-White syndrome generally have a good outcome, and predictors of malignant arrhythmias are similar to those reported for asymptomatic patients with ventricular pre-excitation.

  20. Malignant vasovagal syndrome in two patients with Wolff-Parkinson-White syndrome

    Science.gov (United States)

    Gandhi, N M; Bennett, D H

    2004-01-01

    The presence of Wolff-Parkinson-White (WPW) syndrome in patients presenting with syncope suggests that tachyarrhythmia may be the cause. However, the symptoms require careful evaluation. Two young patients presented with syncope and were found to have WPW syndrome on their ECG. In both patients symptoms were suggestive of vasovagal syncope. During tilt testing, both the patients developed their typical symptoms with a fall in blood pressure and heart rate confirming the diagnosis of malignant vasovagal syndrome. PMID:15020537

  1. The choice of surgical specialization by medical students and their syncopal history.

    Science.gov (United States)

    Rudnicki, Jerzy; Zyśko, Dorota; Kozłowski, Dariusz; Kuliczkowski, Wiktor; Koźluk, Edward; Lelonek, Małgorzata; Piątkowska, Agnieszka; Gajek, Jacek; Negrusz-Kawecka, Marta; Agrawal, Anil Kumar

    2013-01-01

    The aim of the study was to assess whether medical students' fainting outside the university or while witnessing surgical procedures and/or autopsies influenced their choice of a specialization. The study group consisted of 605 medical students (from fourth to sixth year of study) from five medical universities in Poland (325 women, 212 men and 8 responders of an unspecified gender). The median age of subjects studied was 23 years, and the interquartile range was 23-24 years. The students at each university were chosen randomly by the author who worked there and had contact with them. An anonymous questionnaire was developed to gather information regarding demographics, the specialization which each student wanted to choose, the syncope occurrence in the medical history, the syncope and presyncope occurrence during surgery and autopsy as well as the syncopal events' characteristics. The group of 15% of women and 30% of men declared to have pursued the surgical specialization (P<0.001), 29% of women and 56% of men declared the intention to pursue an invasive specialization (P<0.001). As many as 36.0% of women studied and 13.1% of men studied reported syncopal spells outside university (P<0.001). Only 41 students (6.8%) reported that syncope or presyncope in any studied circumstances had an impact on their specialization choice. The multivariate analysis showed that the choice of surgical specialization is related to the male gender and the absence of syncopal spells outside the university. Syncopal and presyncopal spells may affect the professional choices of the medical students. The male gender and a lack of syncope occurrence outside operating room are related to the choice of surgical specialization.

  2. Patient information in radiooncology. Results of a patient survey

    International Nuclear Information System (INIS)

    Schaefer, C.; Dietl, B.; Putnik, K.; Altmann, D.; Herbst, M.; Marienhagen, J.

    2002-01-01

    Background: As a result of increased interest and public demand, providing patients with adequate information about radiooncology has become more and more difficult for the doctor. Insufficient patient information can not only cause anxiety for the patient, but can also lead to legal action against the physician. In order to gain a deeper insight into our clinical practice of providing patient information, we developed a special questionnaire. We describe our first experiences in using this questionnaire at our institute. Patients and methods: We examine the amount of information and level of satisfaction, as well as the agreement of assessment between patient and physician after the provision of standard patient information before and at the end of radiotherapy. 51 consecutive patients were interviewed with a newly designed questionnaire. The first questioning with 13 items was carried out before radiotherapy and the second with ten items was done at the end of treatment. Sum scores for information and satisfaction were defined and agreement was measured by the weighted κ coefficient. Results: Global level of information and satisfaction was good, and a significant increase in information level and a significant decline in satisfaction were seen between questionnaire 1 and 2. Agreement between patient and physician was fair, for example intent of treatment resulted in a κ coefficient of 0.34, and poor for the doctor's role with a κ coefficient of -0.002. Only 52% of the patients who received palliative radiotherapy rated correctly the non-curative intent of treatment, whereas 86% of the patients who received curative radiotherapy made a correct statement. Before radiotherapy, emotional state was often both negatively and positively assessed by the patients. Conclusion: Our short questionnaire is simple and easy to understand. It provides insights into patient information with respect to assessment of the information, satisfaction level, and agreement between

  3. Witnessing loss of consciousness during TMS – Syncope in contrast to seizure

    Directory of Open Access Journals (Sweden)

    Philipp Riedel

    Full Text Available Objective: Transient loss of consciousness (T-LOC can occur during transcranial magnetic stimulation (TMS. T-LOC during TMS can be caused by syncope or seizure. TMS operators explicitly screen participants and are also able to witness clinical manifestations of T-LOC during stimulation. Therefore they have direct access to information necessary to tell the two etiologies apart, if they are well trained on the clinical differences and not only sensitive to the potential risk of seizure induction. We here present a typical case of vasovagal syncope during TMS to contrast its clinical manifestations to that of seizures. Method: We describe an event of T-LOC in a 21 year old healthy woman during single-pulse TMS. Screening, setting, clinical manifestations and advanced diagnostics are reported. Discussion: Based on the detailed description of the case, we discuss why syncope is the most parsimonious etiology for the clinical picture observed in this participant. We provide information on typical clinical features of seizure that were particularly not observed. We also address potential benefits of further diagnostic tools. Additionally, we go into more parameters that can be useful to distinguish syncope from seizure. Conclusion: TMS operators should be well aware of the differentiation of T-LOC in syncopal or ictal in etiology, because they witness T-LOC during TMS. By presenting a typical case of vasovagal syncope during TMS the report in hand provides necessary information and literature to do so. Keywords: TMS, Seizure, Syncope, Adverse-event, T-LOC, Case-report

  4. The problem of dizziness and syncope in old age: transient ischemic attacks versus hypersensitive carotid sinus reflex.

    Science.gov (United States)

    Uesu, C T; Eisenman, J I; Stemmer, E A

    1976-03-01

    In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co-exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre-existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.

  5. Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise

    Directory of Open Access Journals (Sweden)

    Ran Baik

    2010-02-01

    Full Text Available Anomalous origins of coronary arteries are a rare type of disease among children. These anomalies can be categorized into 3 types according to the anatomical relationship of the aorta and pulmonary trunks. Among these types, the interarterial type, as observed in our case, needs early diagnosis and treatment, because it can increase the risk for the patient, causing sudden cardiac death in young individuals. Although there are controversies concerning the management of anomalous origins of the left coronary artery (LCA in children, the result can be very beneficial, if treated accurately. Three well-known methods for correction of anomalous origins of LCA are re-implantation, coronary arterial bypass grafting (CABG, and unroofing. We report on the case of a 12-year-old girl who had chest discomfort and syncope with physical exercise and was later diagnosed with an anomalous origin of LCA by transthoracic echocardiography (TTE and heart computed tomography (CT. She underwent a corrective operation by re-implantation, CABG, and unroofing.

  6. TROMBO GIGANTE DE AURÍCULA DERECHA COMO CAUSA DE ANGINA Y SÍNCOPE / Giant thrombus in right atrium as a cause of angina and syncope

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    José L. Aparicio Suárez

    2012-07-01

    Full Text Available ResumenLas tumoraciones intracardíacas son poco frecuentes, y pueden ser de tipo neoplásicas y no neoplásicas. De estas últimas, los trombos, constituyen las masas más frecuentes. Se presenta un paciente joven, operado en el Cardiocentro "Ernesto Che Guevara" de Villa Clara, Cuba, con antecedentes de trastornos hematológicos desde la infancia, que comienza con episodios de disnea progresiva, angina y síncope; con diagnóstico preoperatorio de tumoración gigante en aurícula derecha que resultó ser un trombo intracardíaco, y se demostró la presencia de un agujero oval permeable. / AbstractIntracardiac tumors are rare, and may be of neoplastic and non-neoplastic types. In the latter, the thrombi are the most frequent masses. This is the case of a young patient operated at the Cardiocentro "Ernesto Che Guevara" of Villa Clara, Cuba, with a history of blood disorders since childhood, starting with episodes of progressive dyspnea, angina and syncope, with pre-operative diagnosis of giant tumor in right atrium which turned out to be an intracardiac thrombus, and the presence of a patent foramen ovale was shown.

  7. Challenging patient safety culture: survey results

    NARCIS (Netherlands)

    Hellings, Johan; Schrooten, Ward; Klazinga, Niek; Vleugels, Arthur

    2007-01-01

    PURPOSE: The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. DESIGN/METHODOLOGY/APPROACH: The Patient Safety Culture Hospital questionnaire was

  8. From syncope to ICD: clinical paths of the Brugada syndrome

    Directory of Open Access Journals (Sweden)

    Ivan Comelli

    2010-09-01

    Full Text Available This review summarizes the evidences in the literature on the management of the Brugada syndrome (BS, an arrhythmogenic disease caused by genetic channelopathies, predisposing to syncope and sudden cardiac death in young, apparently healthy, typically male subjects, in the third and fourth decade of their life. Sudden cardiac death (SCD is defined as natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of symptoms. It ranks among the main causes of death in the western world, with an incidence ranging from 0.36 and 1.28‰ inhabitants per year, equal to 300,000 cases a year in the USA. In the majority of the cases it is due to the onset of arrhythmia in subjects with structural cardiac diseases, especially ischemic heart disease. However, in a non-negligible percentage of the cases, about 5-10%, the SCD arises in relatively young individuals in whom cardiac anomalies cannot be detected using traditional diagnostic techniques. About 20% of these cases can be attributed to SB. In spite of the many efforts produced to identify an effective pharmacological treatment, to date the only aid to reduce the mortality rate in subjects with SB is an implantable cardio-defibrillator (ICD. Since this approach often entails complications, the efforts of the scientific community is now focused on the assessment of the arrhythmic risk. The identification of high-risk subjects is one of the chief objectives in the therapeutic decision-making process. ABSTRACT clinica e terapia emergency

  9. [Determination of prognostic value of the OESIL risk score at 6 months in a Colombian cohort with syncope evaluated in the emergency department; first Latin American experience].

    Science.gov (United States)

    Díaz-Tribaldos, Diana Carolina; Mora, Guillermo; Olaya, Alejandro; Marín, Jorge; Sierra Matamoros, Fabio

    2017-07-14

    To establish the prognostic value, with sensitivity, specificity, positive predictive value, and negative predictive value for the OESIL syncope risk score to predict the presentation of severe outcomes (death, invasive interventions, and readmission) after 6 months of observation in adults who consulted the emergency department due to syncope. Observational, prospective, and multicentre study with enrolment of subjects older than 18 years, who consulted in the emergency department due to syncope. A record was mad of the demographic and clinical information of all patients. The OESIL risk score was calculated, and severe patient outcomes were followed up during a 6 month period using telephone contact. A total of 161 patients met the inclusion criteria and were followed up for 6 months. A score above or equal to 2 in the risk score, classified as high risk, was present in 72% of the patients. The characteristics of the risk score to predict the combined outcome of mortality, invasive interventions, and readmission for a score above or equal to 2 were 75.7, 30.5, 43.1, and 64.4% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. A score above or equal to 2 in the OESIL risk score applied in Colombian population was of limited use to predict the studied severe outcomes. This score will be unable to discriminate between patients that benefit of early admission and further clinical studies. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Penile brachytherapy: Results for 49 patients

    International Nuclear Information System (INIS)

    Crook, Juanita M.; Jezioranski, John; Grimard, Laval; Esche, Bernd; Pond, G.

    2005-01-01

    Purpose: To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. Methods and Materials: From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx. Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had either Iridium wire (n 22) or seeds (n = 4). Four patients had a single plane implant with a plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h, with no correction in total dose, which was 60 Gy in all cases. Results: Median follow-up was 33.4 months (range, 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90.0%. Four men died of penile cancer, and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact

  11. Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Elisabeth eLambert

    2014-07-01

    Full Text Available Orthostatic intolerance is the inability to tolerate the upright posture and is relieved by recumbence. It most commonly affects young women and has a major impact on quality of life and psychosocial well being. Several forms of orthostatic intolerance have been described. The most common one is the recurrent vasovagal syncope (VVS phenotype which presents as a transient and abrupt loss of consciousness and postural tone that is followed by rapid recovery. Another common type of orthostatic intolerance is the postural orthostatic tachycardia syndrome (POTS which is characterized by an excessive rise in heart rate upon standing and is associated with symptoms of presyncope such as light-headedness, fatigue, palpitations and nausea. Maintenance of arterial pressure under condition of reduced central blood volume during the orthostasis is accomplished in large part through sympathetic efferent nerve traffic to the peripheral vasculature. Therefore sympathetic nervous system (SNS dysfunction is high on the list of possible contributors to the pathophysiology of orthostatic intolerance. Investigations into the role of the SNS in orthostatic intolerance have yielded mixed results. This review outlines the current knowledge of the function of the SNS in both VVS and POTS.

  12. Music therapy for coma patients: preliminary results.

    Science.gov (United States)

    Sun, J; Chen, W

    2015-04-01

    The application of quantitative EEG (δ+θ/α+β value) and GCS value to evaluate the role of music therapy for traumatic brain injury coma patients. Forty patients of traumatic brain injury coma were selected to meet the inclusion criteria. Twenty cases were selected for the rehabilitation, neurology and neurosurgery ward, whose families could actively cooperate with, and the patients could receive a long-term fixed nursing staff with formal music therapy (music group). Twenty cases were in the intensive care unit of the rehabilitation, neurology and neurosurgery ward. Their families members cooperated poorly, had often changing nursing staff, and without a formal music therapy (control group). After a one monthe follow up, the GCS value and quantitative EEG (δ+θ/α+β value) were compared between the two groups. Between the two groups, except for the presence or absence of formal music therapy, the rest of treatment had no significant difference and was matched by age, gender, and injury types. In 40 cases of traumatic brain injury patients, the GCS value increased in the music group after treatment when compared to the control group. The difference between the two groups was significant (p coma has obviously an effect on promoting to regain consciousness. The quantitative EEG (δ+θ/α+β value) can be used as an objective index to evaluate the state of brain function.

  13. Syncope prevalence in the ED compared to general practice and population: a strong selection process

    NARCIS (Netherlands)

    Olde Nordkamp, Louise R. A.; van Dijk, Nynke; Ganzeboom, Karin S.; Reitsma, Johannes B.; Luitse, Jan S. K.; Dekker, Lukas R. C.; Shen, Win-Kuang; Wieling, Wouter

    2009-01-01

    Objective: We assessed the prevalence and distribution of the different causes of transient loss of consciousness (TLOC) in the emergency department (ED) and chest pain unit (CPU) and estimated the proportion of persons with syncope in the general population who seek medical attention from either

  14. On the track of syncope induced by orthostatic stress - feedback mechanisms regulating the cardiovascular system

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2009-01-01

    A physiological realistic model of the controlled cardiovascular system is constructed and validated against clinical data. Special attention is paid to the heart rate control. Both sit-to-stand and head-up-tilt experiments are encapsulated by the model. The model may be used in studies of syncop...

  15. What factors influence parents' perception of the quality of life of children and adolescents with neurocardiogenic syncope?

    Science.gov (United States)

    Grimaldi Capitello, Teresa; Fiorilli, Caterina; Placidi, Silvia; Vallone, Roberta; Drago, Fabrizio; Gentile, Simonetta

    2016-05-17

    Health-related quality of life, which can be investigated using self-reports or parental reports, could help healthcare providers understand the subjective perception of well-being of children suffering from recurrent syncopal episodes. Quality of life is not only a measure of health but is also a reflection of patients' and parents' perceptions and expectations of health. This study assessed: 1) the consistency and agreement between pediatric patients' self-reports and parents' proxy-reports of their child's quality of life; 2) whether this patient-parent agreement is dependent on additional demographic and clinical or distress factors; 3) whether the parents' psychological distress influences children's and parents' responses to questionnaires on quality of life. One hundred and twenty-five Italian children aged 6-18 years old (Mean age 12.75, SD 2.73, 48 % female) and their parents completed the Pediatric Quality of Life inventory with self-reports and parent-proxy reports, the Parenting Stress Index - Short Form questionnaire and the Child Behavior Checklist for ages 6-18. Patients' and parents' scores on quality of life were analyzed via an intra-class correlation coefficient, Spearman's correlation coefficient, Wilcoxon signed-rank test, and Bland-Altman plot. Child-rated quality of life was lower than parent-rated quality of life. However, there were no statistically significant differences between pediatric patients' self-reports and their parents' proxy-reports of on quality of life. Clinically significant patient-parent variation in pediatric health-related quality of life was observed. Differences in patient-parent proxy Pediatric Quality of Life inventory Total Scale Score scores were significantly associated with patient age. Concerning parents' proxy-ratings of their children's quality of life on the Pediatric Quality of Life inventory, parental stress was found to be negatively associated with their perceptions of their child's psychological quality

  16. Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case-control study.

    Science.gov (United States)

    Zyśko, D; Szewczuk-Bogusławska, M; Kaczmarek, M; Agrawal, A K; Rudnicki, J; Gajek, J; Melander, O; Sutton, R; Fedorowski, A

    2015-02-01

    Anxiety is an emotion, which stimulates sympathetic nervous outflow potentially facilitating vasovagal reflex syncope (VVS) but reports on anxiety levels in patients with VVS are sparse. We studied anxiety levels in young women (21-40 years) referred for unexplained transient loss of consciousness (TLOC), and age-matched female controls with or without past history of TLOC (≈probable VVS). Referred patients underwent head-up tilt (HUT) according to current ESC Guidelines. State and Trait Anxiety Inventory questionnaire evaluated anxiety levels plus a questionnaire explored risk factors for cardiovascular disease (CVD). Sixty-five of 91 women were diagnosed with VVS on HUT. Among 549 controls, 223 (40.6%) reported at least one episode of TLOC. State-anxiety level in patients with VVS undergoing HUT (42.4 ± 9.3) was higher compared with both controls with (38.3 ± 10.2; P < 0.01) and without past TLOC history (35.9 ± 9.8; P < 0.001). Trait anxiety in patients with VVS (42.7 ± 8.4), and controls with TLOC history (42.4 ± 8.4) was higher compared with controls without TLOC history (39.7 ± 8.5; P < 0.01). In the logistic regression using controls without TLOC as reference, both VVS diagnosis and past history of TLOC were associated with family history of CVD [odds ratio (OR) 2.4, 95% confidence interval (CI), 1.3-4.4; P = 0.007, and 2.3, 1.4-3.6; P = 0.001, respectively], and this association was independent of anxiety level. Trait anxiety and family history of CVD are increased in both young women with VVS and controls with history of TLOC. However, the height of anxiety level does not explain CVD heredity and other mechanisms may link syncope with CVD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  17. A Right-sided Aortic Arch with Kommerell's Diverticulum of the Aberrant Left Subclavian Artery Presenting with Syncope

    Directory of Open Access Journals (Sweden)

    Ming-Hsun Yang

    2009-05-01

    Full Text Available A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.

  18. Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence Neuralgia glossofaríngea com síncope como um sinal de recidiva de câncer do pescoço

    Directory of Open Access Journals (Sweden)

    Reinaldo Teixeira Ribeiro

    2007-12-01

    Full Text Available Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.Neuralgia glossofaríngea com síncope como um sinal de câncer do pescoço é uma condição muito rara. Uma revisão da literatura revelou apenas 29 casos relatados anteriormente. Apresentamos o primeiro caso brasileiro de tal associação. Um homem de 68 anos se apresentou com dores paroxísticas insuportáveis no lado direito do pescoço, algumas vezes seguidas de síncope. Dada a suspeita de recidiva tumoral derivada de uma malignidade cervical tratada previamente, realizou-se um exame de tomografia computadorizada que evidenciou um tumor parafaríngeo direito. As dores e as síncopes foram controladas satisfatoriamente com carbamazepina e o paciente foi submetido à radioterapia paliativa.

  19. Arakeri’s Reflex: an Alternative Pathway for Dento-Cardiac Reflex Mediated Syncope

    Directory of Open Access Journals (Sweden)

    Veena Arali

    2010-03-01

    Full Text Available Introduction: Dentocardiac reflex, a variant of trigeminocardiac reflex elicited specifically during tooth extraction procedures in den-tal/maxillofacial surgery and is believed to cause syncope with an afferent link mediated by posterior superior alveolar nerve. Another variant of trigeminocardiac reflex which is also of interest to the oral and maxillofacial surgeon is oculocardiac reflex which can be triggered by direct or indirect manipulation of eye globe or muscles around it.The hypothesis: Excessive or injudicious pressure or manipulations around the maxillary first molars during extraction procedure are as-sociated with maximum incidence of bradycardia and hypotension than around incisor/ canine/ third molars. This is because; the pressure on eye globe and ophthalmic rectus muscle is maximum during extraction of first molar than incisor/canine and third molars. This observation led us to postulate an alternative pathway for dentocardiac reflex mediated syncope which may possibly justify the maxillary first molar region as a prone factor for the trigger. Evaluation of the hypothesis: Present hypothesis may not confer the specific factor responsible for switch in autonomic response in syncope origin during the tooth extraction procedure, but may provide a clue to where we should be looking.

  20. Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope.

    Science.gov (United States)

    Halliwill, John R; Sieck, Dylan C; Romero, Steven A; Buck, Tahisha M; Ely, Matthew R

    2014-03-01

    Syncope which occurs suddenly in the setting of recovery from exercise, known as post-exercise syncope, represents a failure of integrative physiology during recovery from exercise. We estimate that between 50 and 80% of healthy individuals will develop pre-syncopal signs and symptoms if subjected to a 15-min head-up tilt following exercise. Post-exercise syncope is most often neurally mediated syncope during recovery from exercise, with a combination of factors associated with post-exercise hypotension and loss of the muscle pump contributing to the onset of the event. One can consider the initiating reduction in blood pressure as the tip of the proverbial iceberg. What is needed is a clear model of what lies under the surface; a model that puts the observational variations in context and provides a rational framework for developing strategic physical or pharmacological countermeasures to ultimately protect cerebral perfusion and avert loss of consciousness. This review summarizes the current mechanistic understanding of post-exercise syncope and attempts to categorize the variation of the physiological processes that arise in multiple exercise settings. Newer investigations into the basic integrative physiology of recovery from exercise provide insight into the mechanisms and potential interventions that could be developed as countermeasures against post-exercise syncope. While physical counter maneuvers designed to engage the muscle pump and augment venous return are often found to be beneficial in preventing a significant drop in blood pressure after exercise, countermeasures that target the respiratory pump and pharmacological countermeasures based on the involvement of histamine receptors show promise.

  1. Loss of consciousness and convulsion induced by a ventricular tachycardia mimicking epilepsy in a patient with noncompaction cardiomyopathy : a case report

    NARCIS (Netherlands)

    Dello, S. A. W. G.; Kievit, C.; Dunselman, P. H.; Alings, M.

    Convulsions and loss of consciousness can be caused by, among other things, arrhythmias, conduction disorders or epilepsy. In clinical practice it can be difficult to distinguish between these causes of syncope, even for well-trained specialists. Patients with cardiac syncope have a substantial risk

  2. A 72-year-old patient with bilateral Maisonneuve fractures

    Directory of Open Access Journals (Sweden)

    Thomas Dienstknecht

    2012-07-01

    Full Text Available Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury.

  3. Surgical results of strabismus correction in patients with myelomeningocele

    Directory of Open Access Journals (Sweden)

    Dayane Cristine Issaho

    2015-02-01

    Full Text Available Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture.

  4. Bimanual tapping of a syncopated rhythm reveals hemispheric preferences for relative movement frequencies.

    Science.gov (United States)

    Pflug, Anja; Gompf, Florian; Kell, Christian Alexander

    2017-08-01

    In bimanual multifrequency tapping, right-handers commonly use the right hand to tap the relatively higher rate and the left hand to tap the relatively lower rate. This could be due to hemispheric specializations for the processing of relative frequencies. An extension of the double-filtering-by-frequency theory to motor control proposes a left hemispheric specialization for the control of relatively high and a right hemispheric specialization for the control of relatively low tapping rates. We investigated timing variability and rhythmic accentuation in right handers tapping mono- and multifrequent bimanual rhythms to test the predictions of the double-filtering-by-frequency theory. Yet, hemispheric specializations for the processing of relative tapping rates could be masked by a left hemispheric dominance for the control of known sequences. Tapping was thus either performed in an overlearned quadruple meter (tap of the slow rhythm on the first auditory beat) or in a syncopated quadruple meter (tap of the slow rhythm on the fourth auditory beat). Independent of syncopation, the right hand outperformed the left hand in timing accuracy for fast tapping. A left hand timing benefit for slow tapping rates as predicted by the double-filtering-by-frequency theory was only found in the syncopated tapping group. This suggests a right hemisphere preference for the control of slow tapping rates when rhythms are not overlearned. Error rates indicate that overlearned rhythms represent hierarchically structured meters that are controlled by a single timer that could potentially reside in the left hemisphere. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. A syncopated leap-frog algorithm for orbit consistent plasma simulation of materials processing reactors

    International Nuclear Information System (INIS)

    Cobb, J.W.; Leboeuf, J.N.

    1994-01-01

    The authors present a particle algorithm to extend simulation capabilities for plasma based materials processing reactors. The orbit integrator uses a syncopated leap-frog algorithm in cylindrical coordinates, which maintains second order accuracy, and minimizes computational complexity. Plasma source terms are accumulated orbit consistently directly in the frequency and azimuthal mode domains. Finally they discuss the numerical analysis of this algorithm. Orbit consistency greatly reduces the computational cost for a given level of precision. The computational cost is independent of the degree of time scale separation

  6. Musculoskeletal injuries resulting from patient handling tasks among hospital workers.

    Science.gov (United States)

    Pompeii, Lisa A; Lipscomb, Hester J; Schoenfisch, Ashley L; Dement, John M

    2009-07-01

    The purpose of this study was to evaluate musculoskeletal injuries and disorders resulting from patient handling prior to the implementation of a "minimal manual lift" policy at a large tertiary care medical center. We sought to define the circumstances surrounding patient handling injuries and to identify potential preventive measures. Human resources data were used to define the cohort and their time at work. Workers' compensation records (1997-2003) were utilized to identify work-related musculoskeletal claims, while the workers' description of injury was used to identify those that resulted from patient handling. Adjusted rate ratios were generated using Poisson regression. One-third (n = 876) of all musculoskeletal injuries resulted from patient handling activities. Most (83%) of the injury burden was incurred by inpatient nurses, nurses' aides and radiology technicians, while injury rates were highest for nurses' aides (8.8/100 full-time equivalent, FTEs) and smaller workgroups including emergency medical technicians (10.3/100 FTEs), patient transporters (4.3/100 FTEs), operating room technicians (3.1/100 FTEs), and morgue technicians (2.2/100 FTEs). Forty percent of injuries due to lifting/transferring patients may have been prevented through the use of mechanical lift equipment, while 32% of injuries resulting from repositioning/turning patients, pulling patients up in bed, or catching falling patients may not have been prevented by the use of lift equipment. The use of mechanical lift equipment could significantly reduce the risk of some patient handling injuries but additional interventions need to be considered that address other patient handling tasks. Smaller high-risk workgroups should not be neglected in prevention efforts.

  7. Daptomycin experience in critical care patients: results from a registry.

    Science.gov (United States)

    Brown, Jack E; Fominaya, Cory; Christensen, Keith J; McConnell, Scott A; Lamp, Kenneth C

    2012-04-01

    Vancomycin is often the drug of choice in critically ill patients with gram-positive infections, although circumstances often prevent its use. In these situations, clinicians are frequently left with limited data regarding alternative agents. To describe patients with reported sepsis receiving daptomycin in a critical care unit. This multicenter, noncomparative, noninterventional study identified patients in critical care units, using the Cubicin Outcomes Registry and Experience (CORE) 2005-2009 registry. A descriptive account of patient characteristics, infectious etiology, outcomes at the end of daptomycin therapy, and 30-day mortality is reported. Nonevaluable patients were excluded from the efficacy analysis but included in the safety analysis. We identified 128 patients, 98 (77%) of whom were evaluable for efficacy. Patient characteristics for the efficacy population were 55 (56%) males, 30 (31%) aged 66 years or older, 38 (39%) had creatinine clearance less than 30 mL/min, and 27 (28%) were on dialysis. Common underlying diseases included acute or chronic renal failure 44 (45%), hypertension 40 (41%), and diabetes 27 (28%). Seventy-two (73%) patients were bacteremic. The most common pathogens found were methicillin-resistant Staphylococcus aureus (32%), vancomycin-resistant Enterococcus faecium (21%), and coagulase-negative staphylococci (20%). Prior to daptomycin, antibiotics were used in 84 (86%) patients, most commonly vancomycin (65/84; 77%). The median (range) initial daptomycin dose was 6 mg/kg (3-10) and duration of 10 days (1-58). Overall success rate was 70% (31% cured; 39% improved). Twelve adverse events possibly related to daptomycin were reported in 9 of 128 (7%) patients in the safety population; 4 of these in 4 (3%) patients were serious. The mortality rate within 30 days of completing daptomycin was 42 of 128 (33%) patients. These data provide preliminary results on the use of daptomycin in critically ill patients with complicated conditions

  8. Results of ERAS protocol in patients with colorectal cancer

    Directory of Open Access Journals (Sweden)

    A. O. Rasulov

    2016-01-01

    Full Text Available Objective: explore the use of enhanced recovery after surgery (ERAS in the treatment of patients with colorectal cancer, evaluate its efficacy and safety.Materials and methods. Prospective, single-site, randomized study for the implementation of enhanced recovery after surgery in patients with colorectal cancer has been conducted from October 2014 till the present time. All patients after laparoscopic surgeries undergo treatment according to ERAS protocol, patients after open surgeries are randomized (1:1 in groups of the standard treatment or treatment according to ERAS protocol. The study included patients with localized and locally disseminated colorectal cancer aged from 18 to 75 years, ECOG score ≤ 2. The primary evaluated parameters were the following: the number of postoperative complications (according to Clavien– Dindo classification, postoperative hospital days, incidence of complications and mortality in the 30-day period, timing of activation.Results. Up to date, the study includes 105 patients: laparoscopic group – 51 patients, open-surgery group of patients treated by ERAS protocol – 27 patients, open-surgery group of patients with the standard post-op treatment – 26 patients. Complications requiring emergency surgery for anastomotic leak (p = 0.159 developed in 3.7 % of patients with the standard post-op treatment and in 3.9 % of patients after laparoscopic surgery, while 1 patient required repeat hospitalization. The total number of complications was significantly lower in opensurgery group of patients treated by ERAS protocol compared with the standard post-op treatment (p = 0.021. However, there were no differences between laparoscopic and open-surgery group with the standard post-op treatment (p = 0.159. An average hospitalization stay in patients with the standard post-op treatment was equal to 10 days compared to 7 days in patients treated by ERAS protocol (p = 0.067 and 6 days after laparoscopic

  9. Results of treatment in irradiated testicular seminoma patients

    International Nuclear Information System (INIS)

    Kellokump-Lehtinen, P.

    1990-01-01

    Excellent treatment results have been acieved historically with postoperative radiotherapy in testicular seminoma. In this retrospective study the treatment results of 211 patients with Stage I/II testicular seminoma treated in Finland during the years 1970-1983 were evaluated. 176 (84%) patients received postoperative radiotherapy alone. In addition to radiotherapy, 26 (12%) patients received chemotherapy during the primary treatment. There were 129 Stage I (61%), 66 Stage IIA-B (31%) and 16 Stage IIC (8%) tumors. The 5-year survival rate was 95% in Stage I, 87% in Stage IIA-B and 73% in Stage IIC. In Stage I, seven relapses (relapse rate 6%) occured after irradiation; three of them were cured with second-line therapies. None of the relapses occurred within the radiotherapy field. In Stage IIA-B, 31 patients had only parailiacic + aortic irradiation, 25 patients received both parailiacic + aortic and mediastinal irradiation. With both radiotherapy techniques there was no significant difference in the number of relapses (seven and three) and in the remission rate (94% and 96%). Radiotherapy alone was used on four Stage IIC patients and one of them died during the primary treatment. Two of them relapsed, but could be cured with chemotherapy. These results correspond to those reported in the literature and tye suggest that prophylactic mediastinal irradiation is unneccessary in Stage IIA-B patients. Stage IIC patients should receive chemotherapy initially. (author). 19 refs.; 2 figs.; 2 tabs

  10. Endovascular Treatment of Chronic Mesenteric Ischemia: Results in 14 Patients

    International Nuclear Information System (INIS)

    Chahid, Tamam; Alfidja, Agaicha T.; Biard, Marie; Ravel, Anne; Garcier, Jean Marc; Boyer, L.

    2004-01-01

    We evaluated immediate and long-term results of percutaneous transluminal angioplasty (PTA) and stent placement to treat stenotic and occluded arteries in patients with chronic mesenteric ischemia. Fourteen patients were treated by 3 exclusive celiac artery (CA) PTAs (2 stentings), 3 cases with both Superior Mesenteric Artery (SMA) and CA angioplasties, and 8 exclusive SMA angioplasties (3 stentings). Eleven patients had atheromatous stenoses with one case of an early onset atheroma in an HIV patient with antiphospholipid syndrome. The other etiologies of mesenteric arterial lesions were Takayashu arteritis (2 cases) and a postradiation stenoses (1 case). Technical success was achieved in all cases. Two major complications were observed: one hematoma and one false aneurysm occurring at the brachial puncture site (14.3%). An immediate clinical success was obtained in all patients. During a follow-up of 1-83 months (mean: 29 months), 11 patients were symptom free; 3 patients had recurrent pain; in one patient with inflammatory syndrome, pain relief was obtained with medical treatment; in 2 patients abdominal pain was due to restenosis 36 and 6 months after PTA, respectively. Restenosis was treated by PTA (postirradiation stenosis), and by surgical bypass (atheromatous stenosis). Percutaneous endovascular techniques are safe and accurate. They are an alternative to surgery in patients with chronic mesenteric ischemia due to short and proximal occlusive lesions of SMA and CA

  11. Results of brachytherapy boost in high risk breast cancer patients

    International Nuclear Information System (INIS)

    Battermann, J.J.

    1996-01-01

    Introduction: in breast conserving therapy the role of brachytherapy as a boost after whole breast irradiation is not clear. The series from the Netherlands Cancer Institute show a very high local control rate, but the question could be raised whether all these patients need a brachy boost. Therefore, it was decided at our institute, to deliver a brachy boost only to high risk patients, viz. patients with incomplete resection margins and/or extensive in situ cancer (ECI). Materials and methods: in the period 1988 through 1993 a total of 148 patients with 151 breast tumours received a boost on the tumour bed using brachytherapy. Age varied from 25 till 74 years, with a mean age of 52.3 years. Incomplete resection margins were found in 60 patients, ECI in 31 and both in 49 patients. In the majority of patients, the ECI component was not completely removed. T-stage was unknown in 9 patients. T1 in 83, T2 in 49 and T3 in 10. Nodal status was N0 in 119 and N1 in 33 patients. Infiltrating duct carcinoma was the most common histology. No infiltrating growth was found in 6 patients, but one patient presented a positive node. The interval period between day of operation and day of brachytherapy implantation was between 3 and 4 months in 62%. The mean interval between completion of beam irradiation and day of implantation was 18 days, while 12 patients received their brachytherapy previous to the beam irradiation. External irradiation was with two tangential fields and a total dose of 50 Gy in 25 fractions over 6 weeks (9 fractions in two weeks). The number of needles in two planes. Most patients were implanted under local anaesthesia. Dose rate in 97 patients was 51 - 60 cGy/h. Results: follow-up for patients alive varied from 2 years till 7 years with a mean follow-up period of 4 years. One hundred and twenty five patients are alive, including 6 patients with manifest metastases. Local recurrence was encountered in 8 patients (interval 14 - 60 months, mean 30 months), with

  12. Results of patch testing in 10 patients with peristomal dermatitis.

    Science.gov (United States)

    Landis, Megan N; Keeling, James H; Yiannias, James A; Richardson, Donna M; Nordberg Linehan, Diane L; Davis, Mark D P

    2012-09-01

    Peristomal dermatitis is a common problem in patients with ostomies that is a source of considerable morbidity. Irritant contact dermatitis is most common, but allergic contact dermatitis can also occur. Because of the lack of published reports on patch testing for this indication, we undertook a retrospective study of patch testing results in patients with suspected peristomal allergic contact dermatitis. We sought to describe our patch testing experience with patients referred with peristomal dermatitis. This was a retrospective review of medical records of patients with ostomies and peristomal dermatitis who underwent patch testing in the Mayo Clinic Departments of Dermatology in Jacksonville, FL; Rochester, MN; and Scottsdale, AZ, during a 10-year period (2000-2010). Ten patients with peristomal dermatitis were referred for patch testing (6 in Minnesota, 2 in Florida, and 2 in Arizona). Patients were patch tested to the materials used in their stoma devices, to the standard series, and in some cases to supplemental series. All 10 had at least one allergic patch test reaction, most commonly to stoma paste (3 of 10 patients). Retrospective nature of study via chart review is a limitation. Patch testing is a useful tool for identification of allergens in patients with peristomal dermatitis. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  13. Email for communicating results of diagnostic medical investigations to patients.

    Science.gov (United States)

    Meyer, Barbara; Atherton, Helen; Sawmynaden, Prescilla; Car, Josip

    2012-08-15

    As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare providers to convey increasing volumes of test results to patients is driving investigation of alternative technological solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical investigations to patients. To assess the effects of using email for communicating results of diagnostic medical investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes, including harms, for health professionals, patients and caregivers, and health services. We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions using email for communicating results of any diagnostic medical investigations to patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible. No studies met the inclusion criteria, therefore there are no results to report on the use of email for communicating results of diagnostic medical

  14. Distant gammatherapy results of patients with esophagus cancer

    International Nuclear Information System (INIS)

    Shiraliyev, O.K.; Beibutov, Sh.M.; Quilieva, A.O.; Nasirova, F.J.

    2005-01-01

    Full text: The problem of esophagus cancer therapy gains the particular meaning for Azerbaijan where this disease incidence exceeds the parameters of neighboring countries by almost two times. 1240 patients with esophagus cancer were under our observation for more than 15 years who had been subjected to the distant static gamma therapy on apparatuses 'Agat-R' and 'Rockus M'. There were 732 men (59 % )and 508 women (41 %). The patients' age ranged from 24-88 years. Disease duration since the appearance of the first symptoms till entering to the department was 4-8 months on the average. Esophagus cancer is often localized in the places of the physiological stenosis. So tumour was localised in the neck region esophagus in 45 patients (4.1%), in upper pectoral in 104 ones (9.5%), in middle pectoral in 594 ones (54.5%) in lower pectoral in 299 ones (27.4%) in abdominal regions of esophagus 48 patients(4.5%).The extent of dimensions of tumour esophagus was ranged within 2-13 cm, only it was less than 5 cm in 6.5% patients. The opportune surgical treatment ensures the perfect recovery. However, the early stage of the disease can develop asymptomatically. The patients with the 1st stage of lesion were only 8 (0.8%) with the 2nd one 408(37.4%), with the 3rd one 607(55.7%), with the 4th one 67(6.1%). Radiation therapy was applied in the cases of inoperable and also in patient who were older than 60 or refused operation. 1090 patients (88%) finished the treatment course. Local summary doses have formed 50-70 Grey, the momentary ones-2-2.5 Grey on the medium. The rest of the patients haven't finished the treatment due to several reasons. The results of the treatment are as follows: We observed clinical cure in 389 patients (35.7%), an improvement in 541 (499%), the process stabilisation or an absence of effect in 160 (14.3%). 40.1% of patients lived for more than 1 year, 18.4% for more than 2 years,12.0% for more than 3 years and 7.0% for more than 5 years. It was established

  15. [Administration of Cardiodoron® in patients with functional cardiovascular disorders and/or sleep disorders--results of a prospective, non-interventional study].

    Science.gov (United States)

    Rother, Claudia

    2013-01-01

    Functional cardiovascular disorders (FCD) can be attributed to around 25-40% of all heart patients, i.e. organic causes are not detectable. Characteristic symptoms are tachycardia, palpitations, cardiac arrhythmia, hyperventilation, vertigo, vasovagal syncopes and sleep disorders, with the latter being a problem of its own. Disturbed vegetative rhythms form the basis of these diseases. The medicinal product Cardiodoron counteracts the dysfunctional vegetative rhythmicity with 3 medicinal plants--Primula veris (common cowslip), Hyoscyamus niger (black henbane) and Onopordum acanthium (cotton thistle). By means of a prospective, multicentre, non-interventional study, the development of disease-specific disorders during treatment with Cardiodoron (drops) was supposed to be shown. Between September 2009 and March 2012, 92 physicians documented 501 patients suffering from functional cardiovascular and/or sleep disorders who have been treated with Cardiodoron for 3-6 months. After an initial examination, a final examination after 90 (± 10) days and, in case of continuation of therapy, a follow-up examination after 90 (± 10) days were carried out. Besides 30 symptoms assessed by the physicians, the patients rated their condition on the basis of the complaints list according to v. Zerssen (B-L and B-L') and the Pittsburgh Sleep Quality Index (PSQI) according to Buysse. The severity of functional cardiovascular disorders as well as sleep disorders was significantly reduced. The same applies for all of the documented 30 disease-specific symptoms. Furthermore, the total score of the complaints list was significantly reduced as well as the PSQI. The largest effect regarding all parameters was detectable after 3 months. Continuation of Cardiodoron therapy stabilised the symptomatology once more and resulted in further improvement. On average, patients reported initial improvement after 13 days of treatment. Tolerability was almost consistently assessed with 'very good / good

  16. Cataract surgery in patients with nanophthalmos: results and complications.

    Science.gov (United States)

    Wu, Wayne; Dawson, Daniel G; Sugar, Alan; Elner, Susan G; Meyer, Kathy A; McKey, Jesse B; Moroi, Sayoko E

    2004-03-01

    To evaluate the results and complications of cataract surgery in patients with nanophthalmos. University hospital practice. The records of consecutive patients with nanophthalmos who had cataract surgery from 1978 through 2002 were reviewed for ocular diagnoses, corneal diameter, keratometry, axial length, retinal-choroidal-scleral thickness determined by echography, ocular surgeries, visual acuity, and complications. Eight patients (6 women, 2 men) with a mean age of 59 years were reviewed. Four patients were not previously diagnosed with nanophthalmos; increased retinal-choroidal-scleral thickness (mean 2.41 mm) confirmed the diagnosis. Twelve eyes had cataract extraction with posterior chamber intraocular lens (IOL) implantation, 11 by phacoemulsification and 1 by extracapsular cataract extraction, and 4 eyes had lamellar scleral resections. Additional surgeries included glaucoma laser treatment (8 eyes), cyclocryotherapy (2 eyes), trabeculectomy with scleral resection (1 eye), trabeculectomy combined with phacoemulsification (1 eye), and neodymium:YAG laser capsulotomy (4 eyes). No eye lost vision; however, complications included severe iritis, broken IOL haptic with vitreous loss, posterior capsule opacity, choroidal hemorrhage, phthisis, and aqueous misdirection. Results indicate that echography should be used to assess retinal-choroidal-scleral thickness in eyes that are hyperopic and at risk for narrow-angle glaucoma. Thickening may confirm the diagnosis of nanophthalmos and allow careful preoperative assessment and appropriate operative procedures in these high-risk eyes. With advances in cataract, glaucoma, and uveal effusion treatments, surgical results in patients with nanophthalmos are improving.

  17. Sharing the results of a patient satisfaction audit.

    Science.gov (United States)

    Walker, Kim; Watkins, Rebecca; Newman, Sue; Pullen, Judy; Osborne, Debbie; Milton, Samantha; Davies, Tara

    2018-03-08

    Regular service audits since 2008 gave a stoma care department confidence in the service it provides. In 2016 the department undertook a new audit to benchmark its services, using the Association of Stoma Care Nurses (ASCN) UK Revised Stoma Care Nursing Standards and Audit Tool (2015) . Of the 60 questionnaires given out, 43 were returned (71%). The results highlighted areas of good practice with positive patient feedback. However, it also identified that the team needed to improve documentation when offering patients the opportunity to meet a former patient with a stoma preoperatively and when discussing lifestyle issues. The results demonstrated poor preoperative compliance; this was lower than expected and did not concur with department statistics. The audit highlights the importance of clarity when developing a questionnaire to ensure all respondents not only interpret its meaning in the same way, but also only answer the questions specific to them.

  18. Syncope (Fainting)

    Science.gov (United States)

    ... for Heart.org CPR & ECC for Heart.org Shop for Heart.org Causes for Heart.org Advocate ... loss of consciousness usually related to insufficient blood flow to the brain. It’s also called fainting or " ...

  19. Downsizing, reengineering and patient safety: numbers, newness and resultant risk.

    Science.gov (United States)

    Knox, G E; Kelley, M; Hodgson, S; Simpson, K R; Carrier, L; Berry, D

    1999-01-01

    Downsizing and reengineering are facts of life in contemporary healthcare organizations. In most instances, these organizational changes are undertaken in an attempt to increase productivity or cut operational costs with results measured in these terms. Less often considered are potential detrimental effects on patient safety or strategies, which might be used to minimize these risks.

  20. Treatment's results of hyperthyroid patients with Iodine-131

    International Nuclear Information System (INIS)

    Bastan-Hagh, M.H.; Larijani, B.; Rahim-Tabrizi, P.; Khalili-Fard, A.R.; Baradar-Jalili, R.; Saghari, M.

    2004-01-01

    Introduction: radioiodine ( 131 I) is an effective and inexpensive alternative to surgery in the treatment of thyroid hyper function. The debate today concerns the maximum and minimum ablative doses, and factors leading to hypothyroidism. Patients and method: 1035 hyperthyroid patients treated with weight-adjusted ablative doses of 131 I were retrospectively assessed for treatment outcome or correlated with sex, age, underlying pathology, and administrated dose of 131 I . Results: Thyroid hyper function was more common in women. The greatest proportions of patients were in the 31-40 years age group and the smallest proportion over -70. The commonest underlying pathology was Grave's disease. Men had a lower response rate to 131 I therapy, with 2.4-fold greater probability of persistent hyperthyroidism (P 131 I hypothyroidism decreased with increasing age (P 131 I therapy was seen in patients with toxic adenoma, (P=0.0001). The incidence of hypothyroidism did not show a positive correction with increased administered dose of 131 I (P 131 I was effective in reducing thyroid nodule size. There were 18 cases of temporary hyperthyroidism, all of which recovered to euthyroid status within 12 months. Conclusion: one dose of radioiodine was effective in treatment of hyperthyroid patients in 91.2 % of cases. Age, sex and underlying pathology were determining factors. In most cases the average time to hypothyroidism was reasonably short, obviating the need for long time follow up in these patients

  1. Radiotherapy treatment results of bladder cancer: study of 458 patients

    International Nuclear Information System (INIS)

    Vara Santos, J.; Torre Tomas, A. de la; Romero Fernandez, J.; Regueiro Otero, C.; Clavo Varas, B.; Magallan Sebastian, R.; Valcarcel Sancho, F.; Polo Tolosana, E.; Aragon de la Cruz, G.

    1994-01-01

    Between 1964 to 1990, 458 patients diagnosed of bladder cancer have been treated with radical radiotherapy in our department. The 5-years and 10-years actuarial survival rates were 37% and 27% respectively. The 5-years and 10-years actuarial local control rates, evaluated in 404 patients, were 41% and 38%. In regard to survival, T stage (p=0.013), advanced intravesical extension or multicentrity (p>0.0001), and squamous differentiation (p<0.0001), reached statistical significance as adverse prognostic factors. In 248 patients, with invasive transitional carcinoma, radical radiotherapy alone was used. In this group of patients, T stage (p=0.006) and advanced intravesical extension or multicentrity (p=0.0002) were adverse prognostic factors for survival. Our results suggest that radical radiotherapy must be considered and alternative to surgery in management of bladder cancer. On the basis of prognostic factors evidenced in this series a subgroup of patients with low probability of survival when treated with exclusive radiotherapy are defined. This patients must be included in clinical research protocols. (Author) 44 refs

  2. [Strategies for improving care of oncologic patients: SHARE Project results].

    Science.gov (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  3. Results of Entecavir treatment in patients with chronic hepatitis B

    Directory of Open Access Journals (Sweden)

    Şükran Köse

    2013-12-01

    Full Text Available Objective: This study was designed to determine the efficacy and safety of Entecavir (ETV after 96 weeks treatment in patients with chronic viral hepatitis B (CHB. Methods: Thirty-eight patients were included into the study. The criteria for starting ETV treatment were as follows: elevated ALT levels >upper limit of normal (ULN two times, with HBV-DNA levels ≥5 log10 copies/ml (≥20000 IU/mL, in HBe Ag positive patients, ≥4log10 copies/ml (≥2000IU/mL in HBe Ag negative patients and liver damage was confirmed by histopathology (Knodell HAI ≥4 or fibrosis ≥1. Patients were followed up every 12 weeks by virological and biochemical tests. Results: Twenty-four of 38 patients (63.2% were male. Mean age of patients were 38.6 years, 14 of them were HBeAg positive (36.8%. At baseline, median ALT level was detected as 106.7 IU/ml, median HBV DNA levels were 4.8 x 107 copy/ml, and mean Knodell HAI score was nine. Eleven of 14 HBe Ag positive patients (78.6% were treatment-naïve. No resistance mutation was determined during treatment. Biochemical responses (BR at 48 th and 96th week were 100% and virologic response (VR were 57.1%, and 50%, respectively. Serological response (SR at 48th and 96 th weeks were 35.7% and 42.8% respectively. Fifteen (62.5% of 24 HBe Ag negative patients were treatment-naïve; two patients were detected to have lamivudine resistance mutation. At 48 th and 96 th week, BR was 95.8%, and 100%, respectively; and VR were 83.3% both. Conclusion:In our study, virologic response was significantly high after two years of therapy with Entecavir in HBe Ag negative patients. J Microbiol Infect Dis 2013;3(4: 176-180

  4. Long-range correlation in synchronization and syncopation tapping: a linear phase correction model.

    Directory of Open Access Journals (Sweden)

    Didier Delignières

    Full Text Available We propose in this paper a model for accounting for the increase in long-range correlations observed in asynchrony series in syncopation tapping, as compared with synchronization tapping. Our model is an extension of the linear phase correction model for synchronization tapping. We suppose that the timekeeper represents a fractal source in the system, and that a process of estimation of the half-period of the metronome, obeying a random-walk dynamics, combines with the linear phase correction process. Comparing experimental and simulated series, we show that our model allows accounting for the experimentally observed pattern of serial dependence. This model complete previous modeling solutions proposed for self-paced and synchronization tapping, for a unifying framework of event-based timing.

  5. Patch Test Results of 775 Patients with Allergic Contact Dermatitis

    Directory of Open Access Journals (Sweden)

    Simin Ada

    2010-12-01

    Full Text Available Background and Design: The allergens responsible for allergic contact dermatitis vary among countries and even between different geographical regions within the same country over time. It is of great importance to perform the patch test at certain intervals, to evaluate the results in different centers and to compare them afterwards. Our aim was to evaluate the patch test results in our patients with allergic contact dermatitis.Material and Method: The records of the patients with allergic contact dermatitis, who had been patch tested between May 1997 and March 2009, were analyzed retrospectively. The demographic features such as age and sex, localization of the contact dermatitis, and the patch test results were recorded. Results: Of the 775 patients, 581 (75.2% were females and 194 (25% males. Of all patients, 735 were patch tested with the European Standard Series, 318 - with both the European Standard Series and cosmetic series, and 40-with cosmetic series alone. Of the patients tested with the European Standard Series, 255 (34.7% had at least one positive reaction. The most frequent allergen in the European Standard Series was nickel sulfate (17.3%, followed by cobalt chloride (7.2%, potassium dichromate (3%, fragrance mix (2.9%, and p-phenylenediamine base (2.6%. Of the 358 patients tested with cosmetic series, 82 (22.9% had at least one positive reaction. The 5 most frequently observed cosmetic series allergens were octyl gallate (3.9%, thimerosal (2.2%, sorbitan sesquioleate (2%, Euxyl K 400 (2% and methyldibromo glutaronitrile (1.4%. Conclusion: Our study shows the contact allergen profile of our center over 12 years. The most common allergens and their frequency differ between centers in various cities in Turkey. Those geographical differences should be re-evaluated by further studies performed in the certain time period. The high frequency of reactions to octyl gallate is an important finding in patients suspected of cosmetic allergy

  6. Indeterminate human immunodeficiency virus western blot results in Iranian patients with discordant screening assay results

    International Nuclear Information System (INIS)

    Ravanshad, M.; Sabahi, F.; Mahboudi, F.; Sabahi, F.

    2006-01-01

    The Western blot (WB) assay is the most widely accepted confirmatory assay for the detection and confirmation of antibodies to human immunodeficiency virus type 1 (HIV-1) and 2 (HIV-2). However, indeterminate WB reactivity to HIV-1 and HIV-2 proteins may occur in individuals who do not appear to be infected with HIV. In this study, we describe the results of indeterminate WB reactivity in Iranian patients with discordant screening assays. The samples were obtained from Iranian Blood Transfusion Center, Tehran, Iran and evaluated in the Biotechnology Process Development Center, Pasteur Institute of Iran, Tehran, Iran between 2003 and 2004. A total of 4707 were tested for the presence of HIV-1 antibodies. Six hundred and four (12.8%) patients tested for HIV were positive for HIV-1 antibody. Nine (1.49%) have discordant results among screening assays and indeterminate WB results as interpreted by Centers for Disease Control and Prevention (CDC) criteria. Most (66.7%) of these indeterminate WB results were due to p24 reactivity. However, 2(22.2%) display reactivity to both gp41 and gp120 proteins [Positive by World Health Organization (WHO) criteria]. Of 9 WB assays initially indeterminate by the CDC criteria and with follow-up samples 8(88.8%) became negative when retested subsequently while one (11.1%) remained indeterminate for more than a year and were thus considered negative. In addition all the indeterminate samples were negative when assessed by polymerase chain reaction assay. In general, there were was an 88.8% concordance between the CDC and WHO criteria for an indeterminate WB result. The CDC II criteria for an indeterminate WB result. The CDC II criteria best met the specified objectives for diagnosis in our setting. (author)

  7. Increased heart rate caused by atrial pacing with the closed-loop stimulation function prevented micturition syncope

    Directory of Open Access Journals (Sweden)

    Tatsuo Haraki, MD,PhD

    2013-10-01

    Full Text Available A 70-year-old man had been experiencing syncope several times a year. We implanted a DDD pacemaker with closed-loop stimulation (CLS function. When he urinated early in the morning, his increased atrial pacing rates elevated his heart rate (HR during and after micturition. After implantation of the DDD-CLS mode, he did not experience symptoms. In contrast, in the DDD-R mode, his intrinsic HR changed to atrial pacing after micturition but decreased to the basal rate within 2 min, and he experienced a sense of cold perspiration and presyncope. Increased HRs caused by atrial pacing with the CLS function were useful in the prevention of micturition syncope.

  8. Audiophonological results after cochlear implantation in 40 congenitally deaf patients: preliminary results.

    Science.gov (United States)

    Loundon, N; Busquet, D; Roger, G; Moatti, L; Garabedian, E N

    2000-11-30

    The aim of this study is to evaluate the prognostic factors of audiophonological results in cochlear implant in congenitally deaf patients. Between 1991 and 1996. 40 congenitally deaf children underwent cochlear implantation in our department, at an average age of 7 years (median: 5 years). The results of speech therapy were evaluated with a mean follow-up of 2 years and were classified according to four criteria: perception of sound, speech perception, speech production and the level of oral language. For each criterion, a score was established ranging from zero to four. These scores were weighted according to age such that the results before and after implantation only reflected the changes related to the implantation. The prognostic factors for good results were: a good level of oral communication before implantation, residual hearing, progressive deafness and implantation at a young age. On the other hand, poor prognostic factors were: the presence of behavioral disorders and poor communication skills prior to implantation. Overall, the major prognostic factor for a good outcome appeared to be the preoperative level of oral language, even if this was rudimentary.

  9. Radiotherapy Results of Breast Cancer Patients with Metastatic Bone Disease

    Directory of Open Access Journals (Sweden)

    Ahmet Dirier

    2006-01-01

    Full Text Available Breast cancer patients with bone metastasis who had admitted to Dicle University Department of Radiation Oncology for palliative radiation therapy between September 2001 and December 2003 were evaluated. There were 31 patients (26 female, 5 male. Median age was 43 years (range 23-79. Histopathological subtypes were infiltrating ductal carcinoma (88%, tubulolobuler carcinoma (6% and inflammatory carcinoma (6%. Loci of bone metastasis were vertebra only in twelve patients (39%, non-vertebral bones only in 8 patients (26% and both vertebral and nonvertebral bones in 11 patients (35%. Two patients had refused radiotherapy. Radiation doses were 3000 cGy with 10 fractions in 15 patients, 2000 cGy with 5 fractions in 6 patients and 800 cGy single fraction in eight patients. Complete palliation of pain was achieved in 18 patients (62% and partial palliation was achieved in 11 patients (38%. Treatment related toxicity was grade I-II dermatitis. In conclusion; same respons rates in terms of palliation can be achieved in the three radiotherapy schedules.

  10. [Results of conservative treatment in patients with occult pneumothorax].

    Science.gov (United States)

    Llaquet Bayo, Heura; Montmany Vioque, Sandra; Rebasa, Pere; Navarro Soto, Salvador

    2016-04-01

    An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Virtual simulation. First clinical results in patients with prostate cancer

    International Nuclear Information System (INIS)

    Buchali, A.; Dinges, S.; Koswig, S.; Rosenthal, P.; Salk, S.; Harder, C.; Schlenger, L.; Budach, V.

    1998-01-01

    Investigation of options of virtual simulation in patients with localized prostate cancer. Twenty-four patients suffering from prostate cancer were virtual simulated. The clinical target volume was contoured and the planning target volume was defined after CT scan. The isocenter of the planning target volume was determined and marked at patient's skin. The precision of patients marking was controlled with conventional simulation after physical radiation treatment planning. Mean differences of the patient's mark revealed between the 2 simulations in all room axes around 1 mm. The organs at risk were visualized in the digital reconstructed radiographs. The precise patient's mark of the isocentre by virtual simulation allows to skip the conventional simulation. The visualisation of organs at risk leeds to an unnecessarity of an application of contrast medium and to a further relieve of the patient. The personal requirement is not higher in virtual simulation than in conventional CT based radiation treatment planning. (orig./MG) [de

  12. Results of surgical excision of urethral prolapse in symptomatic patients.

    Science.gov (United States)

    Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

    2017-11-01

    Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

  13. Pharmacological, psychological, and patient education interventions for patients with neck pain: results of an international survey.

    Science.gov (United States)

    Carlesso, Lisa C; Gross, Anita R; MacDermid, Joy C; Walton, David M; Santaguida, P Lina

    2015-01-01

    Examination of practice patterns compared to existing evidence identifies knowledge to practice gaps. To describe the utilization of pharmacological, patient education, primary psychological interventions and relaxation therapies in patients with neck pain by clinicians. An international cross-sectional survey was conducted to determine the use of these interventions amongst 326 clinicians treating patients with neck pain. Nineteen countries participated. Results were analyzed by usage amongst physical therapists (39%) and chiropractors (35%), as they were the predominant respondents. Patient education (95%) and relaxation therapies (59%) were the most utilized interventions. Tests of subgroup differences determined that physical therapists used patient education significantly more than chiropractors. Use of medications and primary psychological interventions were reported by most to be outside of scope of practice. The high rate of patient education is consistent with supporting evidence. However, usage of relaxation therapies is contrary to evidence suggesting no benefit for improved pain or function for chronic neck pain. This survey indicates that patient education and relaxation therapies are common treatments provided by chiropractors and physical therapists for patients with neck pain. Future research should address gaps associated with variable practice patterns and knowledge translation to reduce usage of interventions shown to be ineffective.

  14. Evaluation of culture and antibiogram results in burned patients

    OpenAIRE

    Polat, Yusuf; Karabulut, Aysun; Balcı, Yasemin I.; Çilengir, Mehmet; Övet, Gültekin; Cebelli, Sami

    2010-01-01

    Infections are most common cause of morbidity and mortality in burned patients due to destruction of skin barrier. In this study, we aimed to determine most common microorganisms and their antibiotic susceptibility detected in wound cultures of these patients. Sixty six positive wound cultures were detected in patients admitted to burn clinic of Denizli State hospital between November, 2008 and November, 2009 and were evaluated in the study. Antibiotic susceptibility tests were performed by d...

  15. Complications of intravenous DSA: Results in 500 patients

    International Nuclear Information System (INIS)

    Gross-Fengels, W.; Neufang, K.F.R.; Beyer, D.; Steinbrich, W.

    1987-01-01

    500 patients were studied respectively for complications of intravenous digital subtraction angiography (IV-DSA) performed with non-ionic contrast media, using a central venous injection technique. In 21 patients (4,2%) during or shortly after the procedure 23 systemic, 1 neurologic, and 7 local complications occurred. In addition, 1 patient developed acute renal failure 26 hours after the IV-DSA, whereas 4 patients later showed on thromboses of the catheterised vein. No permanent neurologic or systemic complications and severe allergic reactions were seen. (orig.) [de

  16. Kidney transplant in diabetic patients: modalities, indications and results

    Directory of Open Access Journals (Sweden)

    Rangel Érika B

    2009-08-01

    Full Text Available Abstract Background Diabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy. Conclusion Type 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.

  17. Kyol Goeu (‘Wind Overload’) Part II: Prevalence, Characteristics, and Mechanisms of Kyol Goeu and Near-Kyol Goeu Episodes of Khmer Patients Attending a Psychiatric Clinic

    Science.gov (United States)

    Hinton, Devon; Um, Khin; Ba, Phalnarith

    2009-01-01

    Kyol goeu (literally, ‘wind overload’) is an orthostatically triggered syncopal syndrome often found among Khmer refugees in the US. In the present study, 36 of 100 (36%) Khmer patients attending a psychiatric clinic were found to have suffered a kyol goeu episode in the past, whereas 60 of 100 (60%) patients had experienced a near-kyol goeu event in the last six months. Following a survey-based characterization of kyol goeu, as well as the presentation of case vignettes, the article discusses six mechanisms resulting in the high prevalence of the syndrome. The article concludes by comparing kyol goeu and ataque de nervios. PMID:20808711

  18. Kyol Goeu ('Wind Overload') Part II: Prevalence, Characteristics, and Mechanisms of Kyol Goeu and Near-Kyol Goeu Episodes of Khmer Patients Attending a Psychiatric Clinic.

    Science.gov (United States)

    Hinton, Devon; Um, Khin; Ba, Phalnarith

    2001-12-01

    Kyol goeu (literally, 'wind overload') is an orthostatically triggered syncopal syndrome often found among Khmer refugees in the US. In the present study, 36 of 100 (36%) Khmer patients attending a psychiatric clinic were found to have suffered a kyol goeu episode in the past, whereas 60 of 100 (60%) patients had experienced a near-kyol goeu event in the last six months. Following a survey-based characterization of kyol goeu, as well as the presentation of case vignettes, the article discusses six mechanisms resulting in the high prevalence of the syndrome. The article concludes by comparing kyol goeu and ataque de nervios.

  19. PECULIARITIES OF AUTONOMOUS REGULATION IN THE PATIENTS WITH SYNCOPE LIVING IN AN INDUSTRIAL CITY

    Directory of Open Access Journals (Sweden)

    Илья Дмитриевич Мартынов

    2017-09-01

    Conclusions. Taking into account the changes in the spectral indices of heart rate variability during an active orthostatic test, a pathogenetic approach to the early detection, treatment and prevention of cardiovascular diseases is possible.

  20. Photorefractive keratectomy results in myopic patients with thin cornea eyes

    Directory of Open Access Journals (Sweden)

    Hassan Hashemi

    2015-01-01

    Conclusion: PRK is a safe, effective, and predictable procedure with desirable effects on mesopic CS in patients with corneal thickness <500 μm, which increases HOAs and decreases corneal integrity proportionate to its value before the procedure.

  1. T1 glottis radiotherapy: functional results and patients satisfaction

    International Nuclear Information System (INIS)

    Azoury, F.; Nasr, E.; Nehme Nasr, D.; Ghorra, C.; Fares, G.; Tabchy, B.; Ghorra, C.; Haddad, A.

    2009-01-01

    This retrospective series confirms the efficiency of the radical radiotherapy for the T1 glottal cancers as well as its satisfying tolerance with a low toxicity; most of patients were satisfied of their voice quality. (N.C.)

  2. Psychiatric morbidity in dermatology patients: Frequency and results of consultations

    Directory of Open Access Journals (Sweden)

    Seyhan Muammer

    2006-01-01

    Full Text Available BACKGROUND: Dermatological patients quite commonly depict psychiatric morbidity. PURPOSES: To study the psychiatric morbidity among skin patients of our clinic. METHODS: In the present study, the patients who were treated in the Dermatology Clinic of Inonu University Medical Faculty were evaluated retrospectively. The age, gender, marital status, habits, dermatological and systemic diseases, previously used drugs, current therapy and psychiatric diagnosis of each patient were recorded. FINDINGS: Of 636 patients involved in the study, 15.3% had psychopathological problems, which were depression (32.0%, adjustment difficulty (15.5%, anxiety (13.4%, psychosomatic disorders (10.3%, obsessive-compulsive disorder and conversion (5.1%, dysthymic disorder (4.1%, attention deficit and hyperactivity disorder (2.1%, panic attack (1.0%, premenstrual syndrome, schizophrenia, somatization disorder, insomnia, alcohol dependency, bipolar affective disorder, mental retardation, agoraphobia, social phobia and dementia. The dermatological diseases defined for the patients with psychopathology diagnosis were chronic urticaria (25.8%; psoriasis (15.5%; alopecia areata, totalis and iniversalis (11.3%; acute urticaria, neurodermatitis and Behcet′s disease (5.1%; atopic dermatitis and drug eruptions (4.1%; pemphigus (3.1%; angioedema, contact dermatitis and generalized pruritus (2.1%; folliculitis and the others (1.0%. CONCLUSIONS: Psychiatric morbidity has an affect on the course of dermatological diseases. When required, psychiatric consultation should be sought by dermatology clinics and patients should be followed with the cooperation of dermatologists and psychiatrists. LIMITATION: The indoor-based study had not included any control group and any domicillary patient.

  3. Malnutrition in hospitalized patients: results from La Rioja.

    Science.gov (United States)

    Martín Palmero, Ángela; Serrano Pérez, Andra; Chinchetru Ranedo, Mª José; Cámara Balda, Alejandro; Martínez de Salinas Santamarí, Mª Ángeles; Villar García, Gonzalo; Marín Lizárraga, Mª Del Mar

    2017-03-30

    There is a high malnutrition prevalence in hospitalized patients. To determine the malnutrition prevalence in hospitalized patients of La Rioja Community (Spain) when evaluated with different screening/ evaluation tools and its relationship with hospital stay and mortality. Cross sectional observational study of hospitalized adult patients (age > 18 years old) from medical and surgical departments that underwent within 72 h of their admission a nutritional screening with Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS) 2002, Controlling Nutritional Status (CONUT) y Subjective Global Assessment (SGA). 384 patients (273 medical and 111 surgical) were evaluated. Almost fifty percent of them were considered malnourished independently of the screening/assessment tool used. High concordance was found between SGA and NRS-2002 (k = 0.758). Malnourished patients had a longer hospital stay than those well-nourished (9.29 vs. 7.10 days; p = 0.002), used a greater number of medicines (9.2 vs. 7.4; p = 0.001) and underwent a higher number of diagnostic tests (16.4 vs. 12.5; p = 0,002). Half of the hospitalized patients in the medical and surgical department of La Rioja are malnourished. This is associated with a longer hospital stay, higher use of medicines, diagnostics tests and greater mortality. Malnutrition could be detected with easy screening tools to treat it appropriately.

  4. Posttraumatic Stress Disorder Patients and Results of Violent Behavior

    Directory of Open Access Journals (Sweden)

    Taner Oznur

    2014-08-01

    Full Text Available AIM: High levels of anger and aggression in post-traumatic stress disorder lead to unfavorable social, legal, physical and economic results to family members and the other social layers as much as patients. In this study, it is aimed to investigate the relation between both alcohol-cigarette consumption ratios and anger levels, characteristics of aggressive behaviors and the judicial outcome in cases diagnosed post-traumatic stress disorder due to armed conflict. METHODS: 38 cases diagnosed as post-traumatic stress disorder were included to the study. Pre- and post-traumatic alcohol/cigarette consumption amounts and aggressive behaviors are determined. Impact of Events Scale (Revised (IES-R was used for evaluating post-traumatic stress disorder symptom patterns and severity, Buss Perry Aggression Questionnaire was used for measuring anger and aggression levels, and Taylor and #8217;s Violence Rating Scale was used for evaluating the judicial outcome of aggression. RESULTS: 23 of cases (60.6% were married with children, 13 of cases (34.25 were single and 2 of cases (5.2% were divorced.18 of cases (47.4% were graduate. IES-R total score was 66,9 +/- 12,7, Buss Perry total score was 111,3 +/- 20,5, and Taylor and #8217;s Violence Rate was 2,5 +/- 1,0. When the pre- and post-traumatic aggressive behaviors were compared; physical violence to the partner was increased more than ten times, Physical and verbal violence to social individuals were increased more than four and seven times, respectively. And also it is observed that inflicting damage to property was increased 17 times, reckless driving was increased 11 times, and self-mutilation was increased 5 times. Alcohol consumption was determined as 0 (0 - 126 g/day for pre-trauma cases and 16.5 (0 - 294 g/day for post-trauma cases. Cigarette smoking was determined as 5 (0 and #8211; 40 cigarette/day for pre-trauma cases and 30 (0 -60 cigarette/day for post-trauma cases. CONCLUSION: Post

  5. School Nurses on the Front Lines of Medicine: The Approach to a Student After a Syncopal Event: Don't "PASS OUT".

    Science.gov (United States)

    Hackett, Gretchen; Brady, Jodi; Olympia, Robert P

    2018-03-01

    Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider's office, or directly to the closest emergency department via EMS). This article describes the initial assessment and management of two students presenting after syncopal events.

  6. Patient's safety culture among Tunisian healthcare workers: results ...

    African Journals Online (AJOL)

    Conclusion: our study has allowed us to conclude that all dimensions of patients' safety culture need to be improved among our establishment's professionals. Therefore, more efforts are necessary in order to develop a security culture based on confidence, learning, communication and team work and rejecting sanction, ...

  7. Histopathological results of nasopharyngeal masses of adult patients

    African Journals Online (AJOL)

    ... surgery clinics of University of Port Harcourt Teaching Hospital (UPTH) and Kinx Medical Consultants clinic in Port Harcourt. All the patients had examination under anaesthesia (E/U/A) of the nose and nasopharynx and biopsy. The data collected were documented in a proforma designed for the study by the researchers.

  8. Working out the interstitial and syncopic nature of the human psyche: on the analysis of verbal data.

    Science.gov (United States)

    Roth, Wolff-Michael

    2014-09-01

    Psychology studies the human mind and its development. Although it is often recognized that the human mind needs to be understood as a temporal (developmental) phenomenon between past and future and at the interstices between the idealities of pure Self and Other, the analytic methods interpretive researchers use tend to reify ahistorical and solipsist conceptions of the human being. In this article, I provide examples of an approach to the analysis of verbal data that immediately gets us to the interstitial and syncopic nature of the human psyche.

  9. Identification of high risk patients with hypertrophic cardiomyopathy in a northern Greek population

    Directory of Open Access Journals (Sweden)

    Karvounis Charalambos

    2009-07-01

    Full Text Available Abstract Background The percentage of hypertrophic cardiomyopathy (HCM patients who are in high risk for Sudden Death (SD constitutes only a minority of all HCM population but the incidence of SD in this subset is high (at least 5% annually. The identification of this small but important proportion of high risk HCM patients has been the clue in the clinical evaluation of these patients. Methods Our study cohort consisted from 123 patients with HCM who are currently followed up in our Institution. Five clinical risk factors were assessed: a family history of premature SD, unexplained syncope, Non Sustained Ventricular Tachycardia (NSVT on 24-h ECG monitoring, Abnormal Blood Pressure Response (ABPR during upright exercise testing and Maximum left ventricular Wall Thickness (MWT ≥30 mm. The purpose of our study was the identification of high risk HCM patients coming from Northern Greece. Results Fifteen patients (12.2% of the whole cohort had MWT ≥ 30 mm, 30 patients (24.4% had an ABPR to exercise, 17 patients (13.8% had episodes of NSVT in 24-h Holter monitoring, 17 patients (13.8% suffered from syncope, and 8 patients (6.5% had a positive family history of premature SD. Data analysis revealed that 74 patients (60.1% had none risk factor. Twenty four patients (19.5% had 1 risk factor, 17 patients (13.8% had 2 risk factors, 4 patients (3.25% had 3 risk factors, and 4 patients (3.25% had 4 risk factors, while none patient had 5 risk factors. Twenty five patients (20.3% had 2 or more risk factors. Conclusion This study for the first time confirms that, although a 60% of patients with HCM coming from a regional Greek population are in low risk for SD, a substantial proportion (almost 20% carries a high risk for SD justifying prophylactic therapy with amiodaron or ICD implantation.

  10. Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis

    NARCIS (Netherlands)

    de Sain-van der Velden, M; Kaysen, GA; Barrett, HA; Stellaard, F; Gadellaa, MM; Voorbij, HA; Reijngoud, DJ; Rabelink, TJ

    Increased very low density lipoprotein (VLDL) in nephrotic patients results from a decreased catabolism while increased low density lipoprotein (LDL) results from increased synthesis. Hyperlipidemias a hallmark of nephrotic syndrome that has been associated with increased risk for ischemic heart

  11. Prioritizing the patient: optimizing therapy in rheumatoid arthritis. Results of a patient questionnaire in northern Germany

    Directory of Open Access Journals (Sweden)

    Wollenhaupt J

    2013-05-01

    Full Text Available Jürgen Wollenhaupt,1 Inge Ehlebracht-Koenig,2 André Groenewegen,3 Dieter Fricke41Rheumatologikum Hamburg, Schön Klinik Hamburg Eilbek, Hamburg, Germany; 2Center of Rehabilitation, Bad Eilsen, Germany; 3UCB Pharma SA, Brussels, Belgium; 4UCB Pharma GmbH, Monheim, GermanyPurpose: A 40-question postal survey was developed to gain insight into the nature of difficulties experienced by patients due to rheumatoid arthritis (RA, as well as patient perceptions and priorities regarding their RA treatmentPatients and methods: A total of 3000 Lower Saxony, Germany members of Rheuma-Liga (RL, a patient support group for people with RA, were invited to participate between July 1, and August 20, 2009. The questionnaire was divided into four sections: (1 patient demographics, (2 quality of life (QOL, (3 treatment expectations and, (4 patient perceptions of RL. The questionnaire could be completed in writing or via the internet.Results: Of 959 respondents (response rate = 32.0%, 318 had diagnosed RA and were included in the analysis. The respondents were mostly retired (71.2%, female (83.3%, and >60 years of age (63.5%. Members’ responses indicated that most were generally satisfied with their current treatment (67.3%, considered it efficacious (84.0%, and reported minimal (none or little side-effects (61.2%. Patient involvement in treatment decisions, however, was reportedly low (49.6% felt insufficiently involved. Patients’ primary impairments were reflected in their treatment priorities: mobility (97.0%, ability to run errands/do shopping (97.1%, do the housework (95.6%, and be independent of others (94.2%. The primary service provided by RL and used by respondents was physiotherapy (70.6%, which was reported to benefit physical function and mood by over 90.0% of respondents.Conclusion: RA had a detrimental effect upon respondents' quality of life, specifically impairing their ability to perform daily tasks and causing pain/emotional distress

  12. Radiation therapy in old patients. Side effects and results of radiation therapy in old patients

    International Nuclear Information System (INIS)

    Geinitz, H.; Zimmermann, F.B.; Molls, M.

    1999-01-01

    Background: Despite a growing number of elderly patients receiving radiation therapy little is known about side effects and outcome of irradiation in this section of the population. Methods: In a review article epidemiologic data, aspects of radiation-biology as well as side effects and outcome of radiation therapy of elderly patients are discussed. Results: Cancer incidence rises with age and is exceeding 3.5% for males older than 85 years. With a life expectancy of more than 4 years, curative therapy is indicated even at this age. Furthermore, several retrospective studies indicate that local control and disease-Specific survival after radiation therapy of elderly patients is comparable with that of younger persons. The exception contains elderly patients with grade-III to IV gliomas or with rectal carcinoma who show a reduced survival which is perhaps caused by less aggressive combined treatment (tumor resection). Although some biological and molecular data indicate a rise in radiation sensitivity with growing age like the reduction of the capacity of some DNA-repair enzymes, there is no convincing evidence in animal studies or in retrospective clinical studies that radiation therapy is generally less well tolerated by older individuals. Some age-depending differences in organ toxicities are described in 3 large studies, which evaluate the data of patients who were enrolled in different EORTC-trials: Older patients suffer more of functional mucositis in case of radiation therapy to the head and neck, they have an increased weight loss and a higher frequency of late esophageal damage when irradiated in the thorax, and they show a higher prevalence of sexual dysfunction when treated with radiation therapy to the pelvis. On the other hand younger patients suffer more from acute toxicity like skin damage, nausea, and deterioration of the performance status during pelvic radiotherapy. When discussing the dose intensity of radiation therapy concomitant disease which

  13. Impact of marital status on survival of gastric adenocarcinoma patients: Results from the Surveillance Epidemiology and End Results (SEER) Database.

    Science.gov (United States)

    Qiu, Miaozhen; Yang, Dajun; Xu, Ruihua

    2016-02-15

    Marital status was found to be an independent prognostic factor for survival in various cancer types. In this study, we used the Surveillance, Epidemiology and End Results database to analyze the survival difference among different marital status in the United States. Gastric adenocarcinoma patients from 2004-2012 were enrolled for study. The 5-year cause specific survival (CSS) was our primary endpoint. Totally 29,074 eligible patients were identified. We found that more male patients were married than female. Asian patients had the highest percentages of married than the other races. More married patients were covered by the insurance. Married patients had better 5-year CSS than unmarried, 30.6% vs 25.7%, P married and unmarried patients, hazard ratio: 1.09 (95% confidence interval: 1.01-1.17), P = 0.027. The survival difference was significant in the insured but not in the uninsured patients. Widowed patients had the worst prognosis compared with other groups even though they had more stage I disease and more well / moderate differentiated tumors. These results indicated that unmarried gastric adenocarcinoma patients were at greater risk of cancer specific mortality. We recommend every patient should have access to best available gastric cancer therapy.

  14. Impact of marital status on survival of gastric adenocarcinoma patients: Results from the Surveillance Epidemiology and End Results (SEER) Database

    OpenAIRE

    Qiu, Miaozhen; Yang, Dajun; Xu, Ruihua

    2016-01-01

    Marital status was found to be an independent prognostic factor for survival in various cancer types. In this study, we used the Surveillance, Epidemiology and End Results database to analyze the survival difference among different marital status in the United States. Gastric adenocarcinoma patients from 2004?2012 were enrolled for study. The 5-year cause specific survival (CSS) was our primary endpoint. Totally 29,074 eligible patients were identified. We found that more male patients were m...

  15. Transvenous stimulation of the renal sympathetic nerves increases systemic blood pressure: a potential new treatment option for neurocardiogenic syncope.

    Science.gov (United States)

    Madhavan, Malini; Desimone, Christopher V; Ebrille, Elisa; Mulpuru, Siva K; Mikell, Susan B; Johnson, Susan B; Suddendorf, Scott H; Ladewig, Dorothy J; Gilles, Emily J; Danielsen, Andrew J; Asirvatham, Samuel J

    2014-10-01

    Neurocardiogenic syncope (NCS) is a common and sometimes debilitating disorder, with no consistently effective treatment. NCS is due to a combination of bradycardia and vasodilation leading to syncope. Although pacemaker devices have been tried in treating the bradycardic aspect of NCS, no device-based therapy exists to treat the coexistent vasodilation that occurs. The renal sympathetic innervation has been the target of denervation to treat hypertension. We hypothesized that stimulation of the renal sympathetic nerves can increase blood pressure and counteract vasodilation in NCS. High-frequency stimulation (800-900 pps, 10 V, 30-200 seconds) was performed using a quadripolar catheter in the renal vein of 7 dogs and 1 baboon. A significant increase in blood pressure (BP; mean [SD] systolic BP 117 [±28] vs. 128 [±33], diastolic BP 75 [±19] vs. 87 [±29] mmHg) was noted during the stimulation, which returned to baseline after cessation of stimulation. The mean increase in systolic and diastolic BP was 13.0 (±3.3) (P = 0.006) and 10.2 (±4.6) (P = 0.08), respectively. We report the first ever study of feasibility and safety of high-frequency electrical stimulation of the renal sympathetic innervation to increase BP in animal models. This has potential applications in the treatment of hypotensive states such as NCS. © 2014 Wiley Periodicals, Inc.

  16. Pacemakers in patients with familial dysautonomia--a review of experience with 20 patients.

    Science.gov (United States)

    Gold-von Simson, Gabrielle; Rutkowski, Monika; Berlin, Dena; Axelrod, Felicia B

    2005-02-01

    Familial dysautonomia (FD) is a genetic disease associated with a high incidence of sudden death. If fatal bradyarrhythmia is an etiological factor then the incidence of sudden death should decrease after pacemaker placement. Retrospective review of 596 registered FD patients revealed that 22 FD patients (3.7%) had pacemakers placed between December 1984 and June 2003. Clinical and electrocardiographic indications for placement and demographic data were assessed for 20 of the 22 patients (10 males, 10 females, ages 4 to 48 years). Two patients were excluded because of insufficient data. Prior to pacemaker placement, presenting symptoms were syncope and cardiac arrest, 16/20 (80%) and 6/20 (30 %), respectively. Asystole was the most frequent electrocardiographic finding and was documented in 17/20 patients (85 %). Other electrocardiographic abnormalities included bradycardia, AV block, prolonged QTc and prolonged JTc. The average duration of pacemaker utilization was 5.7 years (range 5 months to 14.5 years). Complications included infection (1 patient) and wire migration (2 patients). In the one patient with infection, the pacemaker was permanently removed. This patient then experienced multiple syncopal episodes and death. There were 7 other deaths. Three deaths occurred suddenly without preceding events, and 4 patients had non-cardiac causes of death. None of these 7 deceased patients had recurrence of syncope after pacemaker placement. In the 12 surviving patients, 6 had recurrence of syncope but none had cardiac arrest. Pacemaker placement may protect FD patients from fatal bradyarrhythmia and may decrease the incidence of syncope. However, data are limited and prospective analysis is needed.

  17. Results of patient specific quality assurance for patients undergoing stereotactic ablative radiotherapy for lung lesions

    International Nuclear Information System (INIS)

    Hardcastle, Nicholas; Clements, Natalie; Cramb, Jim; Wanigaratne, Derrick M.; Chesson, Brent; Aarons, Yolanda; Siva, Shankar; Ball, David; Kron, Tomas

    2014-01-01

    Hypofractionated image guided radiotherapy of extracranial targets has become increasingly popular as a treatment modality for inoperable patients with one or more small lesions, often referred to as stereotactic ablative body radiotherapy (SABR). This report details the results of the physical quality assurance (QA) program used for the first 33 lung cancer SABR radiotherapy 3D conformal treatment plans in our centre. SABR involves one or few fractions of high radiation dose delivered in many small fields or arcs with tight margins to mobile targets often delivered through heterogeneous media with non-coplanar beams. We have conducted patient-specific QA similar to the more common intensity modulated radiotherapy QA with particular reference to motion management. Individual patient QA was performed in a Perspex phantom using point dose verification with an ionisation chamber and radiochromic film for verification of the dose distribution both with static and moving detectors to verify motion management strategies. While individual beams could vary by up to 7 %, the total dose in the target was found to be within ±2 % of the prescribed dose for all 33 plans. Film measurements showed qualitative and quantitative agreement between planned and measured isodose line shapes and dimensions. The QA process highlighted the need to account for couch transmission and demonstrated that the ITV construction was appropriate for the treatment technique used. QA is essential for complex radiotherapy deliveries such as SABR. We found individual patient QA helpful in setting up the technique and understanding potential weaknesses in SABR workflow, thus providing confidence in SABR delivery.

  18. THE RESULTS OF KINESIOTAPING IN PATIENTS WITH SCOLIOSIS

    Directory of Open Access Journals (Sweden)

    Dmitry Anatolevich Kiselev

    2016-10-01

    Full Text Available The kinesiotaping method has put into practice on the Rehabilitation and Sport medicine chair of the RNIMU named by N.I. Pirogov which is situated in the Medical Rehabilitation Department of RDKB. This method showed high theatment efficacy and results were stable and continuous. Kinesiotaping isn’t the main treatment method of scoliosis, but its good efficacy in reaching particular rehabilitation goals, potentiation of some methods of treatment of scoliosis, pain elimination and so on, support the idea to invent this method in the rehabilitation process circle in case of such difficult disease as scoliosis.

  19. Numerous Brugada syndrome-associated genetic variants have no effect on J-point elevation, syncope susceptibility, malignant cardiac arrhythmia, and all-cause mortality

    DEFF Research Database (Denmark)

    Ghouse, Jonas; Have, Christian T; Skov, Morten W

    2017-01-01

    PURPOSE: We investigated whether Brugada syndrome (BrS)-associated variants identified in the general population have an effect on J-point elevation as well as whether carriers of BrS variants were more prone to experience syncope and malignant ventricular arrhythmia and had increased mortality c...

  20. Syncope in children and adolescents as asudden, transient, short-term and spontaneously reversible loss of consciousness caused by adecrease in cerebral perfusion

    Directory of Open Access Journals (Sweden)

    Ewa Nowakowska

    2014-09-01

    Full Text Available Syncope is a common symptom in adolescents who come to the hospital emergency wards. The most common form of syncope is neurogenic type caused by impaired autoregulation of the circulatory system. This syncope is not generally life-threatening condition in a contrast to the less common but most dangerous cardiogenic type (e.g. cardiac arrhythmias due to Wolff–Parkinson–White syndrome, long QT time interval, atrioventricular blocks, haemodynamic obstructions in the outflow tract of the left or right ventricle, cardiomyopathy or coronary abnormalities. This paper refers to a new term, i.e. transient loss of consciousness. According to the new definition of syncope from 2009, temporary loss of consciousness has four components: a sudden occurrence, transient nature, short duration, and spontaneous regression. Currently, there are three main types of syncope associated with the cardiovascular system: neurogenic, orthostatic hypotension and a cardiac. The most common form in adolescents are neurogenic fainting which are often preceded by prodromal symptoms, i.e. decrease in blood pressure and heart rate. They can also occur in response to the stress or unusual situations. In the orthostatic syncope the loss of consciousness occurs in a very short time after the upright position and unlike neurogenic form, usually there are no prodromal symptoms, but tachycardia is present. The rarest, but also the most dangerous form of syncope is a cardiogenic type caused by arrhythmias or structural heart disease. This form may be the first sign of serious heart disease or even precede sudden cardiac death.

  1. Comparative Clinical Profile of Postural Orthostatic Tachycardia Patients With and Without Joint Hypermobility Syndrome

    Directory of Open Access Journals (Sweden)

    Blair P Grubb

    2010-04-01

    Full Text Available Background: Autonomic dysfunction is common in patients with the joint hypermobility syndrome (JHS. However, there is a paucity of reported data on clinical features of Postural orthostatic tachycardia syndrome (POTS in patients suffering from JHS.Methods: This retrospective study was approved by our local Institutional Review Board (IRB. Over a period of 10 years, 26 patients of POTS were identified for inclusion in this study. All these patients had features of Joint Hypermobility Syndrome (by Brighton criterion. A comparison group of 39 patients with other forms of POTS were also followed in the autonomic clinic during the same time. We present a descriptive report on the comparative clinical profile of the clinical features of Postural Orthostatic Tachycardia patients with and without Joint Hypermobility syndrome. The data is presented as a mean±SD and percentages wherever applicable.Results: Out of 65 patients, 26 patients (all females, 20 Caucasians had POTS and JHS. The mean age at presentation of POTS was 24±13 (range 10-53 years vs 41±12 (range 19-65 years, P=0.0001, Migraine was a common co morbidity 73 vs 29% p=0,001. In two patients POTS was precipitated by pregnancy, and in three by surgery, urinary tract infection and a viral syndrome respectively. The common clinical features were fatigue (58%, orthostatic palpitations (54%, presyncope (58%, and syncope (62%.Conclusion: Patients with POTS and JHS appear to become symptomatic at an earlier age compared to POTS patients without JHS. In addition patients with JHS had a greater incidence of migraine and syncope than their non JHS counterparts.

  2. Clinical and electrophysiological evaluation of pediatric Wolff-Parkinson-White patients

    Science.gov (United States)

    Yıldırım, Işıl; Özer, Sema; Karagöz, Tevfik; Şahin, Murat; Özkutlu, Süheyla; Alehan, Dursun; Çeliker, Alpay

    2015-01-01

    Objective: Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electrocardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for the management of these patients with limited access to electrophysiological study. Methods: A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed. Results: One hundred nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia (median age 11 (0.1-18) years), and 14 presented with syncope (median age 12 (6-16) years); 13 were asymptomatic (median age 10 (2-13) years). Induced AF degenerated to ventricular fibrillation (VF) in 2 patients. Of the 2 patients with VF, 1 was asymptomatic and the other had syncope; the accessory pathway effective refractory period was ≤180 ms in both. An intracardiac electrophysiological study was performed in 92 patients, and ablation was not attempted for risk of atrioventricular block in 8 (8.6%). The success and recurrence rate of ablation were 90.5% and 23.8% respectively. Conclusion: The induction of VF in 2 of 109 patients in our study suggests that the prognosis of WPW in children is not as benign as once thought. All patients with a WPW pattern on the ECG should be assessed electrophysiologically and risk-stratified. Ablation of patients with risk factors can prevent sudden death in this population. PMID:26006136

  3. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

    Science.gov (United States)

    Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

  4. Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective

    NARCIS (Netherlands)

    Bode, C.; Taal, E.; Emons, P.A.A.; Galetzka, M.; Rasker, J.J.; Laar, M.A.F.J. van de

    2008-01-01

    This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were

  5. Limited results of group self-management education for rheumatoid arthritis patients and their partners: Explanations from the patient perspective.

    NARCIS (Netherlands)

    Bode, Christina; Taal, Erik; Emons, P.A.A.; Galetzka, Mirjam; Rasker, Johannes J.; van de Laar, Mart A F J

    2008-01-01

    This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were

  6. Patient informed governance of distributed research networks: results and discussion from six patient focus groups.

    Science.gov (United States)

    Mamo, Laura A; Browe, Dennis K; Logan, Holly C; Kim, Katherine K

    2013-01-01

    Understanding how to govern emerging distributed research networks is essential to their success. Distributed research networks aggregate patient medical data from many institutions leaving data within the local provider security system. While much is known about patients' views on secondary medical research, little is known about their views on governance of research networks. We conducted six focus groups with patients from three medical centers across the U.S. to understand their perspectives on privacy, consent, and ethical concerns of sharing their data as part of research networks. Participants positively endorsed sharing their health data with these networks believing that doing so could advance healthcare knowledge. However, patients expressed several concerns regarding security and broader ethical issues such as commercialism, public benefit, and social responsibility. We suggest that network governance guidelines move beyond strict technical requirements and address wider socio-ethical concerns by fully including patients in governance processes.

  7. Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    John P. O’Laughlin

    2016-01-01

    Full Text Available We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient’s QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used. The patient was noted to have mild prolongation of the QT interval on electrocardiogram prior to initiation of hydroxychloroquine therapy which was exacerbated by its use and may have been caused due to toxicity from underlying renal failure.

  8. Positive Result by Serology Indicates Active Helicobacter pylori Infection in Patients with Atrophic Gastritis

    OpenAIRE

    Kokkola, Arto; Rautelin, Hilpi; Puolakkainen, Pauli; Sipponen, Pentti; Färkkilä, Martti; Haapiainen, Reijo; Kosunen, Timo U.

    1998-01-01

    Patients with atrophic corpus gastritis and elevated Helicobacter pylori antibody titers but 13C-urea breath test (13C-UBT) and histology results negative for H. pylori were randomized into eradication therapy or follow-up only. Antibody levels decreased significantly in six out of seven patients in the eradication group, while in the follow-up group, the titers declined in only one out of eight patients. In patients with atrophic corpus gastritis, positive serology results may indicate an on...

  9. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

    Science.gov (United States)

    Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

  10. Surgical treatment results of hand deformities in patients with Apert syndrome

    Directory of Open Access Journals (Sweden)

    Ufuk Nalbantoglu

    2015-12-01

    Results: The mean age at the first operation was 2.7 years and the mean number of operations was 3 per patient. No patient developed graft-flap necrosis and no patients required amputations. All patients were able to perform grasping and pinching functions and families were satisfied with the cosmetic results. Conclusion: Using a two-stage surgical protocol, achieving satisfactory results with a minimal number of operations is possible in patients with Apert Syndrome. [Hand Microsurg 2015; 4(3.000: 53-57

  11. A review of results from patient experience surveys during the introduction of group pre-radiotherapy patient information sessions

    International Nuclear Information System (INIS)

    Chapman, K.; James, S.

    2016-01-01

    Aim: The aims of the survey were to check that group pre-radiotherapy information sessions met patients' needs. The use of virtual technology (VT) through Patient Education And Radiotherapy Learning (PEARL) was incorporated part way through the survey period. Methods: Patients attending group pre-radiotherapy information sessions led by assistant practitioners between March and December 2014 were asked to complete questionnaires after they had attended at least five radiotherapy sessions. Key results: 305 patients attended sessions during the survey period. 129 questionnaires were distributed with 103 returned, resulting in an 80% response rate (Overall rate 34%). 102 (99%) patients responded that they were happy and comfortable to receive their radiotherapy information in a group setting. The majority of patients responded that they felt no additional information should be included. Conclusions and recommendations: The survey highlighted that almost all patients were happy to receive their information in a group setting. Patients attending non PEARL and PEARL sessions indicated high satisfaction levels with no notable differences between the groups. This has allayed MVCC staffs' original concerns that patients may find the use of VT as frightening in patient information sessions, so the centre is now confident to incorporate it in the future. The implementation of these sessions has seemed to be both feasible and an efficient use of staff time. All patients referred for radical breast radiotherapy are now invited to attend. It is recommended that regular patient experience surveys are conducted in the future to ensure they continue to meet patients' needs. - Highlights: • 102 (99%) patients responded happy to receive their information in a group setting. • 86 (83%) patients responded they felt no additional information should be included. • 58 (56%) patients provided complimentary comments about the sessions.

  12. results

    Directory of Open Access Journals (Sweden)

    Salabura Piotr

    2017-01-01

    Full Text Available HADES experiment at GSI is the only high precision experiment probing nuclear matter in the beam energy range of a few AGeV. Pion, proton and ion beams are used to study rare dielectron and strangeness probes to diagnose properties of strongly interacting matter in this energy regime. Selected results from p + A and A + A collisions are presented and discussed.

  13. Patch test results with patients' own perfumes, deodorants and shaving lotions: results of the IVDK 1998-2002.

    Science.gov (United States)

    Uter, W; Geier, J; Schnuch, A; Frosch, P J

    2007-03-01

    Assessment of the value of patch testing patients' own perfumes, eau de toilette, deodorants and shaving lotions with regard to diagnosing contact allergy to fragrances, and an analysis of the spectrum of concurrent patch test reactions to single fragrance allergens. Data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) regarding patch test results with above products brought in by the patient, considered as possible cause of contact dermatitis, were retrospectively analysed. Between 1998 and 2002, 1468 patients were patch tested with 2557 single products (deodorants, n = 1094; eau de toilette, n = 598; perfume, n = 530; and pre- or after-shave, n = 325; remainder not classifiable), mostly 'as is'. Positive reactions were observed in 129 patients (to 191 products). In 58 of these patients, no further patch test reactions to the fragrance mix (FM-I), Myroxylon pereirae resin (balsam of Peru) or 4-(4-hydroxy-4-methyl-pentyl)-3-cyclohexencarboxaldehyde (e.g. Lyral(R)) were found. A strong association between contact sensitivity to the above commercial allergens and positive reactions to products was observed. Some single compounds such as ylang-ylang oil, propolis and especially oak moss absolute are important allergens in the 'perfume-positive' subgroup, but less in a subgroup positive to own deodorants. Patch testing this scope of products, brought in by the patient, can be regarded as a simple, safe and effective method to diagnose clinically relevant contact sensitization - the more so, as the composition of such products is ever-changing, and the sensitivity of established 'screening allergens' is thus insufficient.

  14. How you evaluate treatment results in low back pain patients depends on who the patient is

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    2008-01-01

    and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ), the physical function and bodily...

  15. How you evaluate treatment results in low back pain patients depends on who the patient is

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    2009-01-01

    was to concurrently compare responsiveness and minimal clinically important differences (MCID) for commonly used pain scales and functional instruments in four subpopulations of LBP patients. Methods The Danish versions of the Oswestry Disability Index (ODI), the 23-item Roland Morris Disability Questionnaire (RMQ...

  16. The usefulness of carotid sinus massage in different patient groups.

    Science.gov (United States)

    Kumar, Narasimhan Pradeep; Thomas, Alan; Mudd, Paul; Morris, Robert O; Masud, Tahir

    2003-11-01

    to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls. observational study. teaching hospital. we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type). we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that

  17. Capabilities of gravitational surgery for improvement of treatment results in patients with diabetic foot syndrome

    Directory of Open Access Journals (Sweden)

    M B Akhmedov

    2018-06-01

    Full Text Available Aim. Improvement of complex treatment results in patients with diabetic foot syndrome by introducing methods of gravitational surgery and α-lipoic acid. Methods. The results of treatment were analyzed for 558 patients with diabetic foot syndrome treated in Scientific Centre of Surgery named after M.A. Topchubashov (Baku, Azerbaijan from 1988 to 2015. The age varied from 28 to 83 years. The patients included 416 men and 142 women. The control group included 90 patients who at the perioperative period underwent basic therapy including antibiotics, anticoagulants, antiaggregants, dextrans, angioprotectors, spasmolytics, corticosteroids, narcotic and non-narcotic analgesics. The study group included 468 patients, along with traditional therapy receiving efferent methods (plasmapheresis, ultraviolet blood irradiation, ozone therapy and α-lipoic acid. 282 patients of the study group received outpatient treatment and 186 - complex inpatient surgical treatment. A comparative evaluation of the results was performed separately in three groups: angiopathy, neuropathy, angioneuropathy. The results were evaluated by clinical and instrumental examinations before and after treatment (6, 12, 60 months and more. Results. In the study group a satisfactory result of treatment was registered in 85.5% of patients, in the control group - in 62.2%, unsatisfactory in 14.5 and 37.8% of patients, respectively (p=0.046. Conclusion. The use of efferent methods and α-lipoic acid provided prompt elimination of numerous pathogenetic disorders observed in diabetes mellitus, decrease of amputation frequency and improvement of complex surgical treatment results in patients with diabetic foot syndrome.

  18. Late results of total shoulder replacement in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Søjbjerg, J.O.; Frich, Lars Henrik; Johannsen, H.V.

    1999-01-01

    at the authors' institution. Total shoulder replacement yields satisfactory short and long term results even in patients with severely destructed joints. Pain relief is reliable and significant as reported in short and long term studies. In most patients the functional result is good or acceptable. Although...... range of motion is only slightly increased, a satisfactory overall range of motion is achieved by most patients because of the unaffected scapulothoracic motion. However, deteriorating results, emphasizing the complexity of shoulder arthroplasty, were seen with increasing observation time in patients...

  19. Communicating laboratory results through a Web site: Patients' priorities and viewpoints.

    Science.gov (United States)

    Sabahi, Azam; Ahmadian, Leila; Mirzaee, Moghademeh

    2018-02-28

    Patients can access laboratory results using various technologies. The aim of this study was to integrate the laboratory results into the hospital Web site based on patients' viewpoints and priorities and to measure patients' satisfaction. This descriptive-analytical study was conducted in 2015. First, a questionnaire was distributed among 200 patients to assess patients' priorities to receive laboratory results through the Web site. Second, those who agreed (n = 95) to receive their laboratory results through the Web site were identified. Then, the required changes were made to the hospital Web site based on patients' viewpoints and priorities. Third, patients were divided into two groups. The first group received their laboratory results through the Web site on the date had been announced during their visit to the laboratory. The second group was informed by SMS once their results were shown on the Web site. After receiving laboratory results, patients' satisfaction was evaluated. More than half of the participants (n = 53, 55.8%) were highly satisfied with receiving the results electronically. The higher number of people in SMS group (n = 9, 20.9%) reported that they were satisfied with time-saving compared to other group (n = 2, 3.8%) (P = .04). Participants after receiving the results through the Web site considered the functionalities of reprinting (P Web site based on the patients' viewpoints and priorities can improve patient satisfaction and lower the patients' concern regarding confidentiality of their results. © 2018 Wiley Periodicals, Inc.

  20. Mild trigonocephaly in patients with microcephaly. Surgical results in 12 cases

    International Nuclear Information System (INIS)

    Shimoji, Takeyoshi; Yamashiro, Katsumi; Nagamine, Tomoaki; Kawakubo, Junichi

    2010-01-01

    We have recently diagnosed several cases of mild trigonocephaly associated with microcephaly. The surgical approach is often difficult to decide for such cases. Surgical treatment is often attempted if neuroradiological studies show evidence of increased intracranial pressure. Twelve patients (9 girls and 3 boys) were found to microcephaly during infancy. All patients had symptoms, including varying degrees of mental retardation, delayed language, hyperactivity, motor dysfunctions, and self-mutilation (head banging). Most patients had mild trigonocephaly with microcephaly and tended to be of short stature. Head circumferences were at least 2 standard deviations below the mean for age at the time of surgery. Mild trigonocephaly was diagnosed in all patients by means of 3-dimensional computed tomography. Magnetic resonance of the brain showed no abnormalities in any patient. Plain skull X-ray films showed marked digital markings in 8 patients. Intracranial pressure was measured under normocapnia: results were obtained in 9 patients, and intracranial pressure was increased in 8 patients. Decompressive cranioplasty was performed in all patients. After surgery, chronological measurements showed tendencies for head circumferences to increase in 7 patients. Cognitive impairment showed no change, but other symptoms showed some improvement in all patients. These results suggest that surgery is indicated for patients with mild trigonocephaly associated with microcephaly if intracranial pressure is increased and if magnetic resonance of the brain shows no abnormalities. (author)

  1. Lymph Node Failure Pattern and Treatment Results of Esophageal Cancer Patients Treated with Definitive Radiotherapy

    International Nuclear Information System (INIS)

    Lee, Sun Young; Kwon, Hyoung Cheol; Kim, Jung Soo; Lee, Heui Kwan; Kim, Soo Geon

    2008-01-01

    We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. Materials and Methods: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. Results: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the

  2. Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

    Directory of Open Access Journals (Sweden)

    Nicholas L. DePace

    2018-01-01

    Full Text Available Syncope is difficult to definitively diagnose, even with tilt-table testing and beat-to-beat blood pressure measurements, the gold-standard. Both are qualitative, subjective assessments. There are subtypes of syncope associated with autonomic conditions for which tilt-table testing is not useful. Heart rate variability analyses also include too much ambiguity. Three subtypes of syncope are differentiated: vasovagal syncope (VVS due to parasympathetic excess (VVS-PE, VVS with abnormal heart rate response (VVS-HR, and VVS without PE (VVS-PN. P&S monitoring (ANSAR, Inc., Philadelphia, PA differentiates subtypes in 2727 cardiology patients (50.5% female; average age: 57 years; age range: 12–100 years, serially tested over four years (3.3 tests per patient, average. P&S monitoring noninvasively, independently, and simultaneously measures parasympathetic and sympathetic (P&S activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing. Syncope, as an S-excess (SE with stand, is differentiated from orthostatic dysfunction (e.g., POTS as S-withdrawal with stand. Upon standing, VVS-PE is further differentiated as SE with PE, VVS-HR as SE with abnormal HR, and VVS-PN as SE with normal P- and HR-responses. Improved understanding of the underlying pathophysiology by more accurate subtyping leads to more precise therapy and improved outcomes.

  3. A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

    International Nuclear Information System (INIS)

    Cobben, Lodewijk; Groot, Ingrid; Kingma, Lucas; Coerkamp, Emile; Puylaert, Julien; Blickman, Johan

    2009-01-01

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between EUR 55,746 and EUR 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis. (orig.)

  4. A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

    Energy Technology Data Exchange (ETDEWEB)

    Cobben, Lodewijk [Medisch Centrum Haaglanden, Department of Radiology, Leidschendam (Netherlands); Groot, Ingrid [Medisch Centrum Haaglanden, Department of Surgery, Leidschendam (Netherlands); Kingma, Lucas; Coerkamp, Emile; Puylaert, Julien [Medisch Centrum Haaglanden, Department of Radiology, Den Haag (Netherlands); Blickman, Johan [Universitair Medisch Centrum St Radboud, Department of Radiology, Geert Grooteplein 10, GA, Nijmegen (Netherlands)

    2009-05-15

    To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between EUR 55,746 and EUR 72,534. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis. (orig.)

  5. High-resolution SNP array analysis of patients with developmental disorder and normal array CGH results

    Directory of Open Access Journals (Sweden)

    Siggberg Linda

    2012-09-01

    Full Text Available Abstract Background Diagnostic analysis of patients with developmental disorders has improved over recent years largely due to the use of microarray technology. Array methods that facilitate copy number analysis have enabled the diagnosis of up to 20% more patients with previously normal karyotyping results. A substantial number of patients remain undiagnosed, however. Methods and Results Using the Genome-Wide Human SNP array 6.0, we analyzed 35 patients with a developmental disorder of unknown cause and normal array comparative genomic hybridization (array CGH results, in order to characterize previously undefined genomic aberrations. We detected no seemingly pathogenic copy number aberrations. Most of the vast amount of data produced by the array was polymorphic and non-informative. Filtering of this data, based on copy number variant (CNV population frequencies as well as phenotypically relevant genes, enabled pinpointing regions of allelic homozygosity that included candidate genes correlating to the phenotypic features in four patients, but results could not be confirmed. Conclusions In this study, the use of an ultra high-resolution SNP array did not contribute to further diagnose patients with developmental disorders of unknown cause. The statistical power of these results is limited by the small size of the patient cohort, and interpretation of these negative results can only be applied to the patients studied here. We present the results of our study and the recurrence of clustered allelic homozygosity present in this material, as detected by the SNP 6.0 array.

  6. Safety and tolerability of iobitridol in general and in patients with risk factors: Results in more than 160 000 patients

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, Martin, E-mail: martin.maurer@charite.de [Charite - University Medicine Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Heine, Oliver [Guerbet GmbH, Otto-Vogler-Str. 11, 65843 Sulzbach (Germany); Wolf, Michael [Michael Wolf Information Systems, Viktoriastr. 26, 66346 Puettlingen (Germany); Freyhardt, Patrick; Schnapauff, Dirk; Hamm, Bernd [Charite - University Medicine Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany)

    2011-11-15

    Objective: To review the safety, the tolerability and the diagnostic effectiveness of iobitridol under daily practice conditions in the general population and at-risk patients in a post-marketing surveillance study. Materials and methods: A total of 160 639 patients (55.1% male, 43.6% female, mean age 58.6 years) were analysed in 555 centers. Patients underwent X-ray examinations using iobitridol (Xenetix, Guerbet, Sulzbach, Germany) as IV contrast medium (mean volume 85.6 ml). 21.8% of all patients had at least one risk factor (e.g., renal impairment), 7.3% were at-risk patients with allergies or who had previously reacted to contrast medium. Antiallergic pretreatment before contrast medium administration was given in 1144 patients (0.7%). Adverse events were documented and the image quality was assessed. Results: A diagnosis was possible in 99.5% of all cases. The image quality was rated good or excellent in 92.2%. The adverse event rate (e.g., nausea, urticaria) observed was 0.6% in all patients, 1.6% in patients with allergies and 6.0% in patients with a previous reaction to contrast medium. Adverse events occurred more often in women than in men (p < 0.001). Pretreatment did not decrease the rate of adverse events. The rate of adverse events was not increased in higher doses of iobitridol, even if administered to high-risk patients. Conclusions: Iobitridol was shown to be a safe and well-tolerated contrast medium with a low incidence of adverse events in patients with and without risk factors resulting in a good or excellent image quality in most patients.

  7. [Treatment Strategy and Results of Carotid Endarterectomy in Chronic Renal Failure Patients].

    Science.gov (United States)

    Murahashi, Takeo; Kamiyama, Kenji; Osato, Toshiaki; Watanabe, Toshiichi; Ogino, Tatsuya; Sugio, Hironori; Endo, Hideki; Takahira, Kazuki; Shindo, Koichiro; Takahashi, Shuhei; Nakamura, Hirohiko

    2017-02-01

    The number of patients receiving chronic dialysis treatment in Japan currently exceeds 300,000 people. Few reports have described carotid endarterectomy(CEA)for chronic renal failure patients because of the unacceptable rate of perioperative stroke and other morbidities. A strategy for and treatment results of CEA for chronic renal failure patients in our hospital are described herein. The present study included 6 patients who underwent CEA while receiving dialysis treatment between April 2011 and November 2014. Dialysis treatment was initiated due to diabetes in 4 patients and renal sclerosis in 2 patients. All the patients were men, with a mean age of 74.0 years. Two patients were symptomatic, and four were asymptomatic. In all the patients, heart vascular lesions and arteriosclerosis risk factors were present. Postoperatively, pneumonia transient cranial neuropathy, heart failure, and pneumonia in 1 case required extensive treatment. However, by the time of discharge from hospital, no cases had deteriorated compared with their pre-CEA state. The modified Rankin scale score on discharge was 0-2 for all the patients. CEA can be performed safely in patients receiving dialysis, but further operative procedures and careful postoperative management are likely to be needed for patients with CEA who are receiving dialysis.

  8. SMS messages increase adherence to rapid diagnostic test results among malaria patients: results from a pilot study in Nigeria.

    Science.gov (United States)

    Modrek, Sepideh; Schatzkin, Eric; De La Cruz, Anna; Isiguzo, Chinwoke; Nwokolo, Ernest; Anyanti, Jennifer; Ujuju, Chinazo; Montagu, Dominic; Liu, Jenny

    2014-02-25

    The World Health Organization now recommends parasitological confirmation for malaria case management. Rapid diagnostic tests (RDTs) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood. However, where they have been deployed, adherence to RDT results has been poor, especially when the test result is negative. Few studies have examined adherence to RDTs distributed or purchased through the private sector. The Rapid Examination of Malaria and Evaluation of Diagnostic Information (REMEDI) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria. In total, 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves. Participants were given a free RDT and the appropriate treatment advice based on their RDT result. Short Message Service (SMS) text messages reiterating the treatment advice were sent to a randomly selected half of the participants one day after being tested. Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice. Adherence to RDT results was 14.3 percentage points (P-val <0.001) higher in the treatment group who were sent the SMS. The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points. Further, the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs. There was no difference in adherence for the RDT-positive participants who were sent the SMS. SMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from

  9. Results of home parenteral nutrition in patients with severe inflammatory bowel disease - an alternative for surgery of malnourished patients.

    Science.gov (United States)

    Turkot, Maryla; Sobocki, Jacek

    2017-10-31

    In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition. The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications. A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn's disease or ulcerative colitis. Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work. Home parenteral nutrition positively affects patient's general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate.

  10. Patient, Provider, and System Factors Associated With Failure to Follow-Up Elevated Glucose Results in Patients Without Diagnosed Diabetes

    Directory of Open Access Journals (Sweden)

    Michael E. Bowen

    2017-08-01

    Full Text Available Background: Although elevated glucose values are strongly associated with undiagnosed diabetes, they are frequently overlooked. Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs are not well described. Methods: We conducted a chart review in a comprehensive EMR with a patient portal and results management features. Established primary care patients with no known diagnosis of diabetes and ≥ 1 glucose value >125 mg/dL were included. Follow-up failure was defined as (1 no documented comment on the glucose value or result communication to the patient within 30 days or (2 no hemoglobin A 1c (HbA 1c ordered within 30 days or resulted within 12 months. Associations were examined using Wilcoxon and χ 2 tests. Results: Of 150 charts reviewed, 97 met inclusion criteria. The median glucose was 133 mg/dL, and 20% of patients had multiple values >125 mg/dL. Only 36% of elevated glucose values were followed up. No associations were observed between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures. Automated flagging of glucose values ≥140 mg/dL by highlighting them red in the EMR was not associated with improved follow-up (46% vs 32%; P = .19. Even when follow-up occurred (n = 35, only 31% completed gold standard diabetes testing (HbA 1c within 12 months. Of the resulted HbA 1c tests (n = 11, 55% were in the prediabetes range (5.7%-6.4%. Conclusions: Two-thirds of elevated glucose values were not followed up, despite EMR features facilitating results management. Greater understanding of the results management process and improved EMR functionalities to support results management are needed.

  11. Reaching out for patients: public relations and events with real results.

    Science.gov (United States)

    Kuechel, Marie Czenko

    2010-02-01

    In today's market, the aesthetic physician needs to connect with patients using methods that are personal, educational, and that will glean the interest of prospective patients whose attention and dollars are sought by countless facial plastic surgery competitors near and far. Public relations, or reaching your prospective patient without a direct solicitation (advertising) for services, are traditional means that include media relations and charitable and social events. With the added component of social media, today the opportunities to reach out for new patients and garner real results are more varied and more affordable than ever before. Thieme Medical Publishers.

  12. Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

    Directory of Open Access Journals (Sweden)

    Sivanandy P

    2016-07-01

    Full Text Available Palanisamy Sivanandy,1 Mari Kannan Maharajan,1 Kingston Rajiah,1 Tan Tyng Wei,2 Tan Wee Loon,2 Lim Chong Yee2 1Department of Pharmacy Practice, School of Pharmacy, 2School of Pharmacy, International Medical University, Wilayah Persekutuan Kuala Lumpur, Malaysia Background: Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use.Objective: To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia.Methods: A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted.Results: The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of “staff training and skills” were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup.Conclusion: The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety. Keywords

  13. Communication of Pulmonary Function Test Results: A Survey of Patient's Preferences.

    Directory of Open Access Journals (Sweden)

    Debbie Zagami

    Full Text Available Physician-patient communication in patients suffering from common chronic respiratory disease should encompass discussion about pulmonary function test (PFT results, diagnosis, disease education, smoking cessation and optimising inhaler technique. Previous studies have identified that patients with chronic respiratory disease/s often express dissatisfaction about physician communication. Currently there is a paucity of data regarding patient awareness of their PFT results (among those who have undergone PFTs previously or patient preferences about PFT result communication.We undertook a three-month prospective study on outpatients referred to two Pulmonary Function Laboratories. If subjects had undergone PFTs previously, the awareness of their previous test results was evaluated. All subjects were asked about their preferences for PFT result communication. Subjects were determined to have chronic respiratory disease based on their past medical history.300 subjects (50% male with a median age (± SD of 65 (± 14 years participated in the study. 99% of the study participants stated that they were at least moderately interested in knowing their PFT results. 72% (217/300 of the subjects had undergone at least one PFT in the past, 48% of whom stated they had not been made aware of their results. Fewer subjects with chronic respiratory disease preferred that only a doctor discuss their PFT results with them (28% vs. 41%, p = 0.021.Our study demonstrates that while almost all subjects want to be informed of their PFT results, this does not occur in a large number of patients. Many subjects are agreeable for their PFT results to be communicated to them by clinicians other than doctors. Further research is required to develop an efficient method of conveying PFT results that will improve patient satisfaction and health outcomes.

  14. [An integrated model for examination of aphasic patients and evaluation of treatment results].

    Science.gov (United States)

    Ansink, B J; Vanneste, J A; Endtz, L J

    1980-02-01

    This article is an overview of the literature on integrated, multidisciplinar examination of aphasic patients, its consequences for treatment and the evaluation of the results thereof; the need of virtually standardized methods of investigation for each language is stressed.

  15. Final results of a long-term, clinical follow-up in fatty liver patients

    DEFF Research Database (Denmark)

    Dam-Larsen, Sanne; Becker, Ulrik; Franzmann, Maria-Benedicte

    2009-01-01

    OBJECTIVE: There is increasing focus on non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to conduct a long-term clinical follow-up of patients with biopsy-confirmed fatty liver without inflammation or significant fibrosis (pure fatty liver), to analyse for potential risk....... All admissions, discharge diagnoses and causes of death during follow-up were collected. All surviving patients were invited to a clinical follow-up. RESULTS: The follow-up period was 20.4 and 21.0 years, respectively, for the NAFLD and alcoholic fatty liver disease (AFLD) groups. Two NAFLD patients...... of death. Patients with AFLD died primarily from cirrhosis and other alcohol-related disorders, whereas in patients with NAFLD the main causes of death were cardiovascular disease and cancer. CONCLUSIONS: For patients with pure non-alcoholic fatty liver, survival was good and independent...

  16. Therapeutic Results of Surgery and Radiation Therapy in Younger Patients with Stage IB Cervical Cancer

    International Nuclear Information System (INIS)

    Huh, Gil Cha; Yang, Kwang Mo; Suh, Hyun Suk; Kim, Yong Bong; Lee, Eung Soo; Park, Sung Kwan

    1995-01-01

    Purpose : To evaluate the prognostic importance of age in patients with Stage IB cervical cancer, we examined the relationship between age and survival in patients. Methods and materials : Retrospective analysis was performed on 107 patients were treated with surgery followed by postoperative radiotherapy or radiation alone between October 1983 and August 1993 and 28 patients with Stage IB cervical cancer treated with surgery alone between January 1989 and August 1993 at Inje University Seoul Paik Hospital. Patients ranged in age from 26 to 74 (median 48) and were followed for a median period of 39 months. Patients were divided into two groups; Group A comprising 32 patients with≤age 40 and Group B comprising 75 patients with>age 40. Both Group A and Group B patients were comparable with respect to all covariables studied. Results : The overall 5-year survival and the disease free 5-year survival for the 107 patients studied were 85.2% and 82.1% respectively. The overall survival for group A and Group B was 92% and 83%, respectively(p>0.05). The disease free 5-year survival for Group A and Group B was 82.3% and 82.6%, respectively(p>0.05). There was no difference in both local and distant failure in Group A and Group B. Conclusion : On the basis of the this analysis it is concluded that age alone is a poor indicator of prognosis and should not be used as an indication for adjuvant treatment

  17. Burden of illness in systemic lupus erythematosus: results from a UK patient and carer online survey.

    Science.gov (United States)

    Kent, T; Davidson, A; Newman, D; Buck, G; D'Cruz, D

    2017-09-01

    Objective The objective of this study was to assess the impact of systemic lupus erythematosus (SLE) on patients and carers. Methods Adults with SLE and carers of SLE patients completed a UK-specific online survey covering many aspects of the disease. Surveys were developed in collaboration with an NHS lupus unit and a lupus patient organization. Results A total of 121 patients and 31 carers completed the surveys. Of the 70% of patients initially misdiagnosed with another condition, 59% received treatment for the misdiagnosis. Fatigue was the most debilitating symptom, experienced daily by 79% of patients. The proportion of patients not reporting flares to healthcare providers varied with flare severity: mild flares (43%), moderate flares (15%) and severe flares (5%). Most patients (89%) reported reduced ability to socialize, and 76% had changed employment; of these, 52% stopped working completely. Over one-half (52%) of carers in paid employment missed time from work, and 55% of carers reported a worsened financial status. Most carers (87%) experienced interference with social activities. Conclusion SLE is commonly misdiagnosed and has a considerable impact on the physical, social and financial status of patients and carers. Increased awareness of the disease among healthcare providers and employers of patients and their carers is needed.

  18. The results of transrectal prostate biopsy in patients with low levels of prostate specific antigen

    Directory of Open Access Journals (Sweden)

    Ahmet Ali Sancaktutar

    2012-06-01

    Full Text Available Objectives: The aim of this study is to evaluate the resultsof prostate biopsy of patients who had the prostatespecificantigen (PSA levels below 4 ng/ml.Material and methods: The medical records of 63 patientswho underwent transrectal prostate biopsy, betweenJanuary 2005 and December 2011, due to suspicionof prostate cancer with the PSA levels under 4 ng/mlwere retrospectively reviewed.Results: Transrectal Prostate biopsy was performed to63 patients. Prostate cancer was detected in 12 (19%patients. The mean value of PSA was 2.5 ng/ml. TheGleason score of Prostate cancer patients was 6,8 (5-7and the number of positive cores were 3.Conclusions: The rate of prostate cancer was found as19% in patients with levels of PSA under 4 ng/ml and thisratio is compatible with the results of previous reports.

  19. Social inequalities in patient-reported outcomes among older multimorbid patients--results of the MultiCare cohort study.

    Science.gov (United States)

    von dem Knesebeck, Olaf; Bickel, Horst; Fuchs, Angela; Gensichen, Jochen; Höfels, Susanne; Riedel-Heller, Steffi G; König, Hans-Helmut; Mergenthal, Karola; Schön, Gerhard; Wegscheider, Karl; Weyerer, Siegfried; Wiese, Birgitt; Scherer, Martin; van den Bussche, Hendrik; Schäfer, Ingmar

    2015-02-07

    In this article three research questions are addressed: (1) Is there an association between socioeconomic status (SES) and patient-reported outcomes in a cohort of multimorbid patients? (2) Does the association vary according to SES indicator used (income, education, occupational position)? (3) Can the association between SES and patient-reported outcomes (self-rated health, health-related quality of life and functional status) be (partly) explained by burden of disease? Analyses are based on the MultiCare Cohort Study, a German multicentre, prospective, observational cohort study of multimorbid patients from general practice. We analysed baseline data and data from the first follow-up after 15 months (N = 2,729). To assess burden of disease we used the patients' morbidity data from standardized general practitioner (GP) interviews based on a list of 46 groups of chronic conditions including the GP's severity rating of each chronic condition ranging from marginal to very severe. In the cross-sectional analyses SES was significantly associated with the patient-reported outcomes at baseline. Associations with income were more consistent and stronger than with education and occupational position. Associations were partly explained (17% to 44%) by burden of disease. In the longitudinal analyses only income (but not education and occupational position) was significantly related to the patient-reported outcomes at follow-up. Associations between income and the outcomes were reduced by 18% to 27% after adjustment for burden of disease. Results indicate social inequalities in self-rated health, functional status and health related quality of life among older multimorbid patients. As associations with education and occupational position were inconsistent, these inequalities were mainly due to income. Inequalities were partly explained by burden of disease. However, even among patients with a similar disease burden, those with a low income were worse off in terms of the

  20. Dependence of radiotherapeutic results on tumor size in patients with cervix uteri carcinoma

    International Nuclear Information System (INIS)

    Gabelov, A.A.; Zharinov, G.M.

    1981-01-01

    A method is suggested that permits specifying the primary tumor size on the basis of clinical examination of patients with cervix uteri carcinoma. The values of tumor size have been correlated with long-term results of concomitant radiotherapy in 1358 patients with cervix uteri carcinoma. The data obtained have shown that the primary tumor size is a factor that determines to a large extent radiotherapeutic results in patients with cervix uteri carcinoma. The specification of tumor size values makes it possible to considerably lessen prognostic uncertainty of present-day staging classifications. The structure of radiotherapeutic failures also turned out to be closely associated with the primary tumor size

  1. Results of postoperative 90Sr radiotherapy of keloids in view of patients' subjective assessment

    International Nuclear Information System (INIS)

    Fraunholz, I.B.; Gerstenhauer, A.; Boettcher, H.D.

    2005-01-01

    Background and Purpose: As treatment of keloids is mainly a cosmetic indication, the authors investigated, beyond the recurrence rate, the patients' satisfaction with the result and its correlation with objective medical findings. Patients and Methods: 83 keloids of 66 patients had been irradiated after excision by a uniform protocol with 4 x 5 Gy (strontium-90 [ 90 Sr] surface applicator). A questionnaire was developed and sent out in which, above all, the satisfaction with the therapeutic and cosmetic outcome was obtained. These results were correlated with objective parameters and medical findings which were ascertained during an extra follow-up examination. Results: Among 18 of the 41 patients (44%), who had answered the questionnaire, 19 of the 53 keloids treated (36%) had relapsed. 61% of the patients were extremely or mainly satisfied with the therapeutic outcome, 51% extremely or mainly satisfied with the cosmetic outcome. The relief from former keloid-caused symptoms (therapeutic outcome: p=0.0005; cosmetic outcome: p=0.0011), the ear as keloid localization (p=0.0008 and p=0.0197), and male gender (therapeutic outcome: p=0.0423) were significantly associated with higher satisfaction. The recurrence rate as well as the extent of radiation side effects had no significant influence on patients' assessment. Conclusion: Cosmetic aspects like the dermal side effects and the patients' satisfaction should be taken into account when evaluating the results of radiotherapy in keloids. (orig.)

  2. Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

    Science.gov (United States)

    Sivanandy, Palanisamy; Maharajan, Mari Kannan; Rajiah, Kingston; Wei, Tan Tyng; Loon, Tan Wee; Yee, Lim Chong

    2016-01-01

    Background Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use. Objective To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia. Methods A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted. Results The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of “staff training and skills” were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup. Conclusion The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety. PMID:27524887

  3. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome.

    Science.gov (United States)

    David, Tirone E; Armstrong, Sue; Maganti, Manjula; Colman, Jack; Bradley, Timothy J

    2009-10-01

    The appropriateness of aortic valve-sparing operations in patients with Marfan syndrome has been questioned. This study examines the long-term results of these operations in patients with Marfan syndrome. From 1988 to 2006, 103 consecutive patients with Marfan syndrome (mean age, 37 +/- 12 years) and aortic root aneurysm had aortic valve-sparing operations. Emergency surgery was performed in 11 patients: 8 for acute type A aortic dissection and 3 for unexplained persistent chest pain. Fourteen patients also had mitral valve surgery. The technique of aortic valve reimplantation was used in 77 patients, and aortic root remodeling was used in 26 patients. Patients were followed prospectively and underwent annual echocardiographic studies. The mean follow-up was 7.3 +/- 4.2 years and 100% complete. There was 1 operative death and 5 late deaths. Four of the 6 deaths were due to complications of aortic dissections. The patients' survival at 15 years was 87.2% compared with 95.6% for the general population of Ontario matched for age and sex. Seven patients had important aortic insufficiency: 4 mild to moderate, 2 moderate, and 1 moderate to severe. Freedom from greater than mild aortic insufficiency at 15 years was 79.2%. Three patients, all after aortic root remodeling, had aortic valve replacement, 2 for aortic insufficiency and 1 for endocarditis. At the most recent follow-up, 97 patients were alive: 86 were in functional class I, and 11 were in functional class II. Aortic valve-sparing operations provided excellent clinical outcomes in this series of patients with Marfan syndrome. Postoperatively, complications of aortic dissections were the leading cause of death.

  4. Risk stratification of patients with locally aggressive differentiated thyroid cancer. Results of the MSDS trial

    International Nuclear Information System (INIS)

    Riemann, B.; Kraemer, J.A.; Schober, O.; Schmid, K.W.; Dralle, H.; Dietlein, M.; Schicha, H.; Sauerland, C.; Frankewitsch, T.

    2010-01-01

    The Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined group of patients with locally aggressive thyroid carcinomas (pT4; AJCC/UICC 1997). The aim of the present study was to compare the survival of patients with minimum and extensive extrathyroidal growth according to the new AJCC/UICC TNM staging system 2009. Patients, methods: The follow-up data of 347 patients were analysed. Patients were reclassified according to the current AJCC/UICC 2009 classification. The event-free and overall survival was evaluated using Kaplan-Meier analysis. In addition, postoperative complications and status of disease were documented. Results: 327 patients were assigned to stage pT3 and 20 patients to stage pT4a, respectively. Median follow-up was 6.1 years (range 0.04-9.8 years). 92.5% of patients reached complete remission. There were 7.8% recurrences in the thyroid bed, in locoregional lymph nodes and/or in distant sites. The overall survival was >98% both in pT3 and pT4a patients (p = n. s.). In contrast, the event-free survival was significantly less favourable in pT4a patients (p < 0.001). Using multivariate analysis the following parameters were significant predictors of event-free survival: histological tumour type, degree of extrathyroidal extension and nodal metastasis (p < 0.05). Conclusions: The MSDS patients with locally aggressive differentiated thyroid cancer showed an excellent overall survival during a median follow-up of 6.1 years. According to the current AJCC/UICC 2009 classification, pT3 patients with minimal extrathyroidal extension revealed a significantly better event-free survival than pT4a patients with extensive extrathyroidal growth. (orig.)

  5. Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism.

    Science.gov (United States)

    Meyer, Ashley N D; Murphy, Daniel R; Al-Mutairi, Aymer; Sittig, Dean F; Wei, Li; Russo, Elise; Singh, Hardeep

    2017-07-01

    Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

  6. Resource Utilisation and Costs of Depressive Patients in Germany: Results from the Primary Care Monitoring for Depressive Patients Trial

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    Christian Krauth

    2014-01-01

    Full Text Available Background. Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective. Materials and Methods. Data were collected from the primary care monitoring for depressive patients trial (PRoMPT of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period. Results. Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year. Conclusion. The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage.

  7. Oncological, surgical and functional results of the treatment of patients after hemipelvectomy due to metastases

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    Grzegorz Guzik

    2018-02-01

    Full Text Available Abstract Background Metastatic lesions localized in the pelvis cause pain, pathological fractures and decrease quality of patients life. Limited data are avaliable to compare the oncological, surgical and functional outcomes after different surgeries in patients with metastatic pelvic tumors. Most of the works presents the results of hemipelvectomy performed in patients with primary malignant bone tumors. The objectives of this study were to assess the outcome of patients after internal hemipelvectomy due to cancer metastases. Methods Over the period 2010–2015 at the Department of Orthopaedic Oncology in Brzozów, 34 patients with metastases to the pelvis were treated. This study group comprised of 21 men and 13 women. The mean age was 67 (range: 51–79 for men and 56 (range: 41–77 for women. The majority of the treated patients suffered from myeloma (12 patients and breast cancer (8 patients. Following the Enneking system classification guidelines, tumours were found in zone I (5 cases, zone II (18 cases, zone III (4 cases. Tumour involvement of both zones (II and III considered 7 patients. The following resections were accomplished: wide in 11 cases, marginal in 17 cases, and intralesional in 6 cases. 18 patients were postoperatively treated with 8 Gy single-dose radiotherapy. 25 patients underwent bone reconstruction using either Lumic prostheses (9 cases or the Harrington technique (16 cases. The mean follow-up period was 2.1 years (range: 1.2–6 years. The analysis covered patients’ survival, number of local recurrences, functional results and effectiveness of surgical treatment, considering the type, number and reason of complications. Results Eight patients died. Overal survival calculated with Kaplan- Meier curve was 48.2% for 34 patients. Mean survival was 3.85 years. There were no statistically significant differences in overall survival depending on the type of metastasis resection. In this group, local tumour recurrences

  8. Cosmetic results in early stage breast cancer patients with high-dose brachytherapy after conservative surgery

    International Nuclear Information System (INIS)

    Torres, Felipe; Pineda, Beatriz E

    2004-01-01

    Purpose: to reveal cosmetic results in patients at early stages of low risk breast cancer treated with partial accelerated radiotherapy using high dose rate brachytherapy. Methods and materials: from March 2001 to July 2003,14 stages l and ll breast cancer patients were treated at the Colombian national cancer institute in Bogota with conservative surgery and radiotherapy upon the tumor bed (partial accelerated radiotherapy), using interstitial implants with iridium 192 (high dose rate brachytherapy) with a dose of 32 Gys, over 4 days, at 8 fractions twice a day. Results: with an average follow up of 17.7 months, good cosmetic results were found among 71.4 % of patients and excellent results among 14.3% of patients, furthermore none of the patients neither local nor regional or distant relapses. Conclusion: among patients who suffer from breast cancer at early stages, it showed is possible to apply partial accelerated radiotherapy upon the tumor bed with high doses over 4 days with good to excellent cosmetic results

  9. Patch and Prick Tests in Hand Eczema: Results of A Sixty Seven Patient Series

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    Bilge Fettahlıoğlu Karaman

    2017-12-01

    Full Text Available Objective: The patch and prick tests have a place in the management of patients with hand eczema. In this study, we investigated whether some of the clinical features patients with hand eczema could provide us with the predictability of skin test results. Methods: In Çukurova University Faculty of Medicine, 67 consecutive patients with hand eczema; evaluated in terms of duration of disease, morphology and severity. All of the patients were undergoes patch tested with the European Standard Series, and needle testing with routine aeroallergens. Results: Patch test with at least one allergen was positive in 46.3% of the patients; wheras this rate was 23.9% for prick test. The likelihood of having a contact sensitivity of patients complaining of hand eczema for at least three years was statistically more significant [odds ratio (OR 0.9]. Although statistically not significant, it is less likely to be sensitized to patients with keratotic and/or licheniform hand eczema (OR 0.3. The severity of hand eczema was not predictive of patch test, there was no indicator of needle test positivity. Conclusion: We strongly recommend patch testing in all patients with prolonged hand eczema.

  10. The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

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    Walter J. Gomes

    Full Text Available Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8, Northeast (5, South (3, and Center-West (1. The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG, mitral valve, aortic valve (either conventional or transcatheter, surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS, 9.6% from the supplemental (private insurance healthcare systems; and 7.3% from private (out-of -pocket clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

  11. Nonelective colon cancer resections in elderly patients: results from the dutch surgical colorectal audit.

    Science.gov (United States)

    Kolfschoten, N E; Wouters, M W J M; Gooiker, G A; Eddes, E H; Kievit, J; Tollenaar, R A E M; Marang-van de Mheen, P J

    2012-01-01

    The aim of the study was to assess which factors contribute to postoperative mortality, especially in elderly patients who undergo emergency colon cancer resections, using a nationwide population-based database. 6,161 patients (1,172 nonelective) who underwent a colon cancer resection in 2010 in the Netherlands were included. Risk factors for postoperative mortality were investigated using a multivariate logistic regression model for different age groups, elective and nonelective patients separately. For both elective and nonelective patients, mortality risk increased with increasing age. For nonelective elderly patients (80+ years), each additional risk factor increased the mortality risk. For a nonelective patient of 80+ years with an American Society of Anesthesiologists score of III+ and a left hemicolectomy or extended resection, postoperative mortality rate was 41% compared with 7% in patients without additional risk factors. For elderly patients with two or more additional risk factors, a nonelective resection should be considered a high-risk procedure with a mortality risk of up to 41%. The results of this study could be used to adequately inform patient and family and should have consequences for composing an operative team. Copyright © 2012 S. Karger AG, Basel.

  12. Validation and results of a questionnaire for functional bowel disease in out-patients

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    Skordilis Panagiotis

    2002-05-01

    Full Text Available Abstract Background The aim was to evaluate and validate a bowel disease questionnaire in patients attending an out-patient gastroenterology clinic in Greece. Methods This was a prospective study. Diagnosis was based on detailed clinical and laboratory evaluation. The questionnaire was tested on a pilot group of patients. Interviewer-administration technique was used. One-hundred-and-forty consecutive patients attending the out-patient clinic for the first time and fifty healthy controls selected randomly participated in the study. Reliability (kappa statistics and validity of the questionnaire were tested. We used logistic regression models and binary recursive partitioning for assessing distinguishing ability among irritable bowel syndrome (IBS, functional dyspepsia and organic disease patients. Results Mean time for questionnaire completion was 18 min. In test-retest procedure a good agreement was obtained (kappa statistics 0.82. There were 55 patients diagnosed as having IBS, 18 with functional dyspepsia (Rome I criteria, 38 with organic disease. Location of pain was a significant distinguishing factor, patients with functional dyspepsia having no lower abdominal pain (p Conclusions This questionnaire for functional bowel disease is a valid and reliable instrument that can distinguish satisfactorily between organic and functional disease in an out-patient setting.

  13. Prevalence and Treatment Management of Oropharyngeal Candidiasis in Cancer Patients: Results of the French Candidoscope Study

    International Nuclear Information System (INIS)

    Gligorov, Joseph; Bastit, Laurent; Gervais, Honorine; Henni, Mehdi; Kahila, Widad; Lepille, Daniel; Luporsi, Elisabeth; Sasso, Giuseppe; Varette, Charles; Azria, David

    2011-01-01

    Purpose: The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy. Methods and Materials: Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment. Results: Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%). Conclusion: OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.

  14. The results of high tibial open wedge osteotomy in patients with varus deformity

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    Mahmood Jabalameli

    2013-07-01

    Full Text Available Background: High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities.Methods: This retrospective study conducted on twenty nine patients (36 knees undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from 2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than 20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD 27.64 (±10.88. The mean (±SD of follow up time was 4.33 (±1.7. All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in 15 cases (42.5% casting and in the rest T.Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC and modified Larson indices were improved after operation, but there was no significant difference between two groups.Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

  15. Primary progressive aphasia patients evaluated using diffusion tensor imaging and voxel based volumetry-preliminary results

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    Fábio Pascotto de Oliveira

    2011-06-01

    Full Text Available There are individuals who have a progressive language deficit without presenting cognitive deficits in other areas. One of the diseases related to this presentation is primary progressive aphasia (PPA. OBJECTIVE: Identify by means of diffusion tensor imaging (DTI and measurements of cortical volume, brain areas that lead to dysphasia when presenting signs of impaired connectivity or reduced volume. METHOD: Four patients with PPA were evaluated using DTI, and measurements of cortical volumes in temporal areas. These patients were compared with two normal volunteers. RESULTS: There is a trend to a difference in the number and volume of related fibers between control group and patients with PPA. Comparing cortical volumes in temporal areas between groups yielded a trend to a smaller volume in PPA patients. CONCLUSION: Patients with PPA have a trend to impairment in cortical and subcortical levels regarding relevant areas.

  16. Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients

    International Nuclear Information System (INIS)

    Paloyan, E.; Lawrence, A.M.; Oslapas, R.; Shah, K.H.; Ernst, K.; Hofmann, C.

    1983-01-01

    Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism

  17. Clinical history in management of suspected syncope: A powerful diagnostic tool

    NARCIS (Netherlands)

    Sutton, Richard; van Dijk, Nynke; Wieling, Wouter

    2014-01-01

    In this paper, the role of history taking as a diagnostic tool in patients with transient loss of consciousness (TLOC) is addressed. From a literature review it can be demonstrated that, if properly performed, the history is a powerful diagnostic tool, which in the majority of cases proves to be the

  18. Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia

    Science.gov (United States)

    Li, Ji; Wang, Chang; Liu, Xiaoliang; Liu, Qiuju; Lin, Hai; Liu, Chunshui; Jin, Fengyan; Yang, Yan; Bai, Ou; Tan, Yehui; Gao, Sujun; Li, Wei

    2018-01-01

    Abstract To evaluate nutritional status in adult patients with acute leukemia (AL) using patient-generated subjective global assessment (PG-SGA) and to investigate the influence of nutritional status on prognosis. We observationally investigated 68 adult patients with newly diagnosed AL who received PG-SGA at the First Hospital of Jilin University between May 2013 and July 2015. Clinical features, chemotherapy regimens, biochemical indexes, body composition, complete remission (CR) rate, minimal residual disease (MRD), survival time, and side-effects of chemotherapy were compared between patients with and without severe malnutrition. Mean PG-SGA scores of the total patients were 6.1 ± 4.0, and 19 of 68 (27.9%) patients had severe malnutrition (PG-SGA score ≥9). Patients with acute myeloid leukemia (AML) had higher scores than those with acute lymphocytic leukemia (ALL; P = .011) and high-risk patients had higher scores regardless of whether they had AML or ALL (AML, P = .012; ALL, P = .043). Univariate analysis showed that severe malnutrition was correlated with age (P = .041), transferrin (P = .042), Karnofsky Performance Status score (P = .006), and C-reactive protein (CRP) (P = .018). Multivariate analysis demonstrated that severe malnutrition was associated with CRP (hazard ratio [HR] = 1.020, 95% confidence interval [CI]: 1.002–1.039, P = .026). No difference was found in CR rate (P = .831) between patients with and without malnutrition, but those who were severely malnourished had higher MRD (P = .048 in AML patients, P = .036 in ALL patients) and more gastrointestinal side-effects (P = .014). Severe malnutrition was also associated with inferior overall survival (HR = 0.243, 95% CI: 0.063–0.945, P = .041) but not with event-free survival (HR = 0.808, 95% CI: 0.338–1.934, P = .663). Severe malnutrition defined by PG-SGA in adult patients with de novo AL may result in poor outcome

  19. Patient perspectives on Parkinson’s disease therapy in Japan and the United States: results of two patient surveys

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    Hattori N

    2012-07-01

    Full Text Available Nobutaka Hattori,1 Kenichi Fujimoto,2 Tomoyoshi Kondo,3 Miho Murata,4 Mark Stacy51Department of Neurology, Juntendo University School of Medicine, Tokyo; 2Department of Neurology, Jichi Medical University, Tochigi; 3Department of Neurology, Wakayama Medical University, Wakayama; 4Department of Neurology, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan; 5Division of Neurology, Duke University, Durham, NC, USABackground: Despite evidence suggesting that patient attitudes towards therapy may influence treatment outcomes, the impact of these factors on treatment for Parkinson’s disease is poorly understood. These two surveys, based in Japan and the US, investigated the attitudes of patients towards antiparkinsonian medications, the complications of these therapies, and how these differ across geographies.Methods: The US PRELUDE survey collected data from May 13 to May 20, 2003, from 300 interviews with patients with Parkinson’s disease from the National Parkinson Foundation. The Japanese survey was carried out from June to December 2008 in a stepwise manner using questionnaires (n = 3548 followed by interviews with those who had consented to participate in the questionnaire (n = 407. Both surveys assessed the attitudes of patients towards therapies for Parkinson’s disease and associated complications.Results: Dyskinesia was not a major challenge of therapy for Parkinson’s disease, and wearing-off caused greater concern in the US, while hallucinations had a greater emphasis in Japan. Patients who had previously experienced dyskinesia were less concerned about this side effect than those who had not. Although pill burden was thought to be a concern in the US, Japanese patients did not indicate that pill burden would limit their drug intake. There were also discrepancies between the perspectives and concerns of patients and those of their treating physicians.Conclusion: Recognizing patient perspectives regarding therapies for

  20. Preferences of patients undergoing hemodialysis – results from a questionnaire-based study with 4,518 patients

    Directory of Open Access Journals (Sweden)

    Janssen IM

    2015-06-01

    Full Text Available Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis

  1. Use of information sources by cancer patients: results of a systematic review of the research literature

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    Kalyani Ankem

    2006-01-01

    Full Text Available Objectives. Existing findings on cancer patients' use of information sources were synthesized to 1 rank the most and least used information sources and the most helpful information sources and to 2 find the impact of patient demographics and situations on use of information sources. Method. . To synthesize results found across studies, a systematic review was conducted. Medline and CINAHL were searched to retrieve literature on cancer patients' information source use. The retrieved articles were carefully selected according to predetermined criteria, and several articles were eliminated in a systematic approach. Analysis. The twelve articles that met the criteria were systematically analysed by extracting data from articles and summarizing data for the purpose of synthesis to determine the meaning of findings on most used information sources, least used information sources, most helpful information sources, effect of patient characteristics on preference for an information source, and effect of patient situations on preference for an information source. Results. In descending order of use, health care professionals, medical pamphlets, and family and friends were most used information sources. Internet and support groups were least used. In descending order of helpfulness, books, health care professionals and medical pamphlets were found to be most helpful information sources. Younger patients used health care professionals and certain forms of written information sources more than older patients. Conclusion. . The systematic review shows that many areas of cancer patients' information source use have been either neglected or barely analysed. An in-depth understanding of cancer patients' use of information sources and the characteristics in information sources they consider to be helpful is important for developing successful interventions to better inform patients.

  2. Complaints from emergency department patients largely result from treatment and communication problems.

    Science.gov (United States)

    Taylor, David McD; Wolfe, Rory; Cameron, Peter A

    2002-03-01

    Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.

  3. What do Patients Want From Their Radiation Oncologist? Initial Results From a Prospective Trial

    International Nuclear Information System (INIS)

    Bhatnagar, Ajay K.; Land, Stephanie R.; Shogan, Alyson; Rodgers, Edwin E.; Heron, Dwight E.; Flickinger, John C.

    2007-01-01

    Purpose: To assess patients' initial physician preferences using a newly developed instrument. Methods and Materials: A total of 182 patients with a primary diagnosis of prostate, breast, or lung cancer referred for consultation to University of Pittsburgh Cancer Institute Department of Radiation Oncology enrolled in our institutional review board-approved protocol. All patients completed patient preference instrument surveys before meeting their radiation oncologist. Survey responses to 10 statements were categorized into three groups (agree, neutral, or disagree), and the association of survey responses by cancer site was tested with chi-squared tests. Results: Ninety-nine percent of all patients preferred to be addressed by their first name in encounters with their radiation oncologist. There were significant associations of Item 3 (hand holding) with gender (p = 0.039) and education (p = 0.028). The responses to Item 5, a statement that patients would feel uncomfortable if the radiation oncologist offered to hug them at the end of treatment, was significantly associated with disease site (p < 0.0001). Further analysis was performed for Item 5 and revealed that the male lung cancer patients had a much higher rate of disagreement with Item 5 compared with prostate cancer patients (37% vs. 18%). Conclusions: Results of this study may afford greater insight and foster better understanding of what patients want from their radiation oncologist. For breast, lung, and prostate cancer patients, initial preferences for their radiation oncologist are generally similar, according to this tool. However, there are important difference among cancer sites (and gender) regarding physical contact at the end of treatment

  4. Iatrogenic hypernatremia in hemodialysis patients: A result of erroneous online conductivity monitor and conductivity meter reading.

    Science.gov (United States)

    Obialo, Chamberlain I; John, Smitha; Bashir, Khalid

    2017-10-01

    Hyponatremia is common in chronic kidney disease and in end stage kidney disease (ESKD) but hypernatremia is infrequent in ESKD. The incidence of hypernatremia is higher in ambulatory peritoneal dialysis (PD) than in hemodialysis (HD) patients. In PD patients it is often a result of excessive ultrafiltration but in HD it is often a result of dialysate composition errors. Dialysate composition errors can inadvertently cause either hyponatremia or hypernatremia. We present two cases of symptomatic hypernatremia which manifested as increased thirst, excessive weight gain and worsening hypertension in HD patients. The hypernatremia was caused by a combination of errors in online conductivity reading and a faulty hand held conductivity meter. Symptoms were relieved in both patients after replacement of the dialysis machine. © 2017 International Society for Hemodialysis.

  5. Osteoporosis pharmacotherapy following bone densitometry: importance of patient beliefs and understanding of DXA results

    DEFF Research Database (Denmark)

    Brask-Lindemann, Dorthe; Cadarette, S M; Eskildsen, P

    2011-01-01

    . Quadratic weighted kappa was used to estimate agreement between self-report and actual DXA results. Multivariable logistic regression was used to evaluate predictors of understanding of diagnosis, and correlates of treatment initiation and persistence. Results A total of 717 patients responded (72...

  6. Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

    Science.gov (United States)

    Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

    2003-03-01

    The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

  7. Long-term results of radioiodine (131I) therapy in 331 patients with Graves' disease

    International Nuclear Information System (INIS)

    Saito, Shintaro; Sakurada, Toshiro; Yamamoto, Makiko; Yoshida, Katsumi; Kaise, Kazuo

    1980-01-01

    To evaluate the long-term results of 131 I treatment for Graves' disease, the thyroid function was studied in 331 patients 5 - 17 years after this therapy. Twenty-five patients were hypothyroid and had already been on thyroid medication. Among the remaining 306 patients without any treatment for thyroid disorder, 188 patients (61.4%) had a normal thyroid-stimulating hormone (TSH) level (less than 10 μU/ml) of whom 151 were euthyroid with normal thyroxine (T 4 ) and triiodothyronine (T 3 ) level. 118 patients (38.6%) had a high TSH level, of whom 22 were hypothyroid with low T 4 and T 3 levels and 38 were with normal T 3 and low T 4 levels, and 14 patients out of this 38 were clinically hypothyroid. Although all of the patients with high TSH levels do not require the replacement therapy for hypothyroidism, the overt hypothyroidism seems to occur sooner or later in patients with a lower T 4 level. Among 331 patients studied, 61 (18.4%) were clinically hypothyroid. The incidence of hypothyroidism was 20.7% after 10 years of 131 I treatment and 33% after 15 - 17 years. The incidence of patients with high TSH levels was 50% after 10 years of 131 I treatment and 60% after 15 - 17 years. Both of cumulative incidence of hypothyroidism and patients with high TSH levels increased linearly with years after the treatment, which coincided with the linear decrease of mean T 4 and T 3 levels and linear increase of mean TSH level with years after the treatment. The difference of positive incidence of antithyroid antibodies between cases of normal TSH level and high TSH level was not significant. (author)

  8. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas

    International Nuclear Information System (INIS)

    Pollock, Bruce E.; Stafford, Scott L.

    2005-01-01

    Introduction: The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. Methods: Between 1992 and 2001, 49 patients had radiosurgery for dural-based masses of the cavernous sinus presumed to be meningiomas. The mean patient age was 55.5 years. The mean tumor volume was 10.2 mL; the mean tumor margin dose was 15.9 Gy. The mean follow-up was 58 months (range, 16-144 months). Results: No tumor enlarged after radiosurgery. Twelve of 38 patients (26%) with preexisting diplopia or facial numbness/pain had improvement in cranial nerve function. Five patients (10%) had new (n = 3) or worsened (n = 2) trigeminal dysfunction; 2 of these patients (4%) underwent surgery at 20 and 25 months after radiosurgery despite no evidence of tumor progression. Neither patient improved after partial tumor resection. One patient (2%) developed an oculomotor nerve injury. One patient (2%) had an ischemic stroke related to occlusion of the cavernous segment of the internal carotid artery. Event-free survival was 98%, 85%, and 80% at 1, 3, and 7 years after radiosurgery, respectively. Univariate analysis of patient and dosimetric factors found no analyzed factor correlated with postradiosurgical morbidity. Conclusions: Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit

  9. [Nursing Experience With a Patient With Gastrostomy Leakage Resulting in Moisture-Associated Skin Damage].

    Science.gov (United States)

    Hsu, Mei-Yu; Hsu, Hsiao-Hui; Lyu, Ji-Yan

    2016-10-01

    Leakage is a common complication of gastrostomy. Exposure of the skin surrounding the gastrostomy tube to moisture or chemical irritants may cause moisture-associated skin damage (MASD) and seriously affect the patient's quality of life. This case study describes a nursing experience with gastrostomy leakage that resulted in MASD. An assessment conducted from July 29, 2015 to August 20, 2015 revealed that heavy gastronomy leakage had caused extensive skin erosion, ulceration, hyperplasia, and superficial infection. Simultaneously, the patient was required to conduct complex stoma care, which resulted in physical and psychological exhaustion. Changes in traditional tube and wound care were discussed on multiple occasions with an interdisciplinary healthcare team. Based on the evidence-based literature, we provide gastrostomy and MASD management strategies. Through team collaboration, we prevented gastric contents from contacting the patient's skin directly, improved patient comfort, controlled effluent and skin infections, maintained fluid and electrolyte balances, and acce-lerated the healing of the damaged skin. We recommend that healthcare professionals caring for patients with gastrostomy leakage be provided with early skin protection programs to learn the standard methods for identifying and correcting leakage factors, containing effluent, and adequately stabilizing the gastrostomy tube in order to reduce the impact on the patient's quality of life. In addition, patient education on tube and skin care should be provided to prevent the reoccurrence of complications.

  10. Results of combined modality treatment in patients with primary unresectable cancer of the oral cavity

    International Nuclear Information System (INIS)

    Kawecki, A.; Starosciak, S.; Towpik, E.; Jagielska, B.; Lenartowicz, B.; Pietras, M.; Szutkowski, Z.; Kiprian, D.

    2001-01-01

    Neoadjuvant chemotherapy may improve the results of treatment for primarily unresectable cancer of the oral cavity. The aim of this study was to estimate the tolerance and early results of neoadjuvant chemotherapy followed by surgical resection of oral cavity cancer, with immediate reconstruction and adjuvant radiotherapy. 56 patients hospitalized at the Department of Head and Neck Cancer of the Maria Sklodowska-Curie Memorial Cancer Centre - Institute of Oncology between August 1997 and June 2000 were enrolled for the purpose of the study. When tumour regresion was observed after 2-4 courses of neoadjuvant chemotherapy consisting of cisplatin, 5-fluorouracil, methotrexate, vinblastin, etoposide and leucovorin, the patients were referred for surgical resection with immediate reconstruction, followed by adjuvant radiotherapy. Regression of the primary tumor and lymph nodes of the neck was observed in 41 patients, all of whom were referred for radical surgery followed by adjuvant radiotherapy. The tolerance of combined treatment was acceptable. Complete regression was obtained in 37/56 patients. During observation 12 patients failed due to locoregional progression and 2 due to distant metastases. 23/56 patients (41 %) are alive without evidence of disease. Neoadjuvant chemotherapy allows for radical resection in a majority of patients with primarily unresectable cancer of the oral cavity. The tolerance of treatment is good. What is important, radiotherapy and chemotherapy do not impair wound healing and vascularity of musculo-cutaneous island flaps

  11. Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department.

    Science.gov (United States)

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia

    2017-06-02

    To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Erkan Hirik

    2016-03-01

    Full Text Available Purpose: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy(NSRP due to localized prostate cancer (PCa. Materials and Methods: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED were included in the study. The mean age of the patients was 64 (54-72. On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5 test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. Results: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72% had normal erectile function; of the remaining patients in the study six (12% presented with mild, two (4% with moderate, and six (12% with severe ED. Six months after surgery, 35 patients (70% had normal erectile function while seven (14% had mild, three (6% moderate and five (10% severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6thmonth follow-up (p > 0.05. Three patients reported adverse effects with tadalafil including flushes in 2 (3.6% and a headache in 1 (1.8%. Conclusions: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of

  13. Surgery in older cancer patients - recent results and new techniques: worth the investment?.

    Science.gov (United States)

    van Leeuwen, Barbara L; Huisman, Monique G; Audisio, Riccardo A

    2013-01-01

    Recent developments in oncogeriatric surgery focus on several items - preoperative risk estimation and identification of frail patients and optimalization of perioperative care. New screening tools are being evaluated and show promising results. There is increasing evidence that preoperative training of frail patients might decrease the rate of postoperative complications and increase survival. The recent trend towards individualized treatment schemes will certainly be of benefit for the elderly population. More tools are becoming available to answer the most difficult question of all, namely whether surgery is the optimal treatment in this individual frail elderly oncogeriatric patient. Copyright © 2013 S. Karger AG, Basel.

  14. [Late results of surgical treatment in patients, suffering complicated forms of chronic pancreatitis].

    Science.gov (United States)

    Ratchyk, V M; Orlovs'kyĭ, D V; Makarchuk, V A; Zemlians'kyĭ, D É; Orlovs'kyĭ, V V

    2014-12-01

    Late results of treatment were analyzed in 58 patients, suffering complicated forms of chronic pancreatitis, to whom draining and resectional-draining surgical interventions were performed. On average the patients age was (49.90 ± 8.59) yrs, there were 42 (72.4%) men and 16 (27.6%) women. During period of the 3 yrs postoperative follow- up in the patients the pain syndrome severity have reduced essentially and quality of life improved, comparing with those indices after resectional-draining interventions.

  15. Evaluation of photopatch test allergens for Indian patients of photodermatitis: Preliminary results

    Directory of Open Access Journals (Sweden)

    Nidhi Jindal

    2011-01-01

    Full Text Available Background: There is a strong need to develop a photopatch test tray suitable for Indian patients of photodermatitis as European/Scandinavian photopatch test trays may not be wholly relevant for them. Aim: We carried out this study using photoallergens relevant in the Indian context to determine their relevance in patients of photodermatitis. Methods: Thirty patients (M:F, 23:7 between 19 and 76 years of age of photodermatitis and 10 controls were patch- and photopatch tested with 20 common photoallergens. In addition, the patients were also (photo patch tested with articles of daily use as and when these were suspected to be the cause. Results: Forty-three positive reactions to one or more antigens were seen in 22 (74% patients. Fourteen positive photopatch tests to seven allergens were observed in 10 (33% patients, and nine (30% of them had a definite relevance. The most common contact allergen was fragrance mix (FM (30%, followed by p-phenylenediamine (20% and Parthenium hysterophorous (17%. The definite relevance of the patch- and photopatch tests could be correlated in 47% of these patients. Conclusions: FM is the most common contact and photocontact allergen among the various photopatch test antigens. Although differences in technique and evaluation make direct comparison between different centers difficult, still photopatch testing remains an integral part and gold standard for the work-up of the photosensitive patients.

  16. The effectiveness of neurofeedback on cognitive functioning in patients with Alzheimer's disease: Preliminary results.

    Science.gov (United States)

    Luijmes, Robin E; Pouwels, Sjaak; Boonman, Jacko

    2016-06-01

    Alzheimer's disease (AD) is the most common form of dementia. In quantified EEG (qEEG), the AD patients have a greater amount of theta activity compared with normal elderly individuals. Little is known about the effect of neurofeedback in patients with dementia. The objective of this study was to examine whether neurofeedback has a positive effect on cognitive performance in patients with AD. Ten patients with qEEG meeting criteria for AD received neurofeedback training. Participants were aged between 61 and 90 years. All patients underwent the CAMCOG test designed to assess cognitive functioning pre- and post-treatment. The individual results, analyzed with a reliable change index (RCI), showed that patients who received neurofeedback treatment had stable cognitive functions. These patients showed improvement in memory after neurofeedback and other cognitive functions were stable. In addition, an improvement was observed in recall of information and recognition. Patients with AD who received neurofeedback treatment had stable or improved cognitive performance. Future research should focus on the design of high quality randomized controlled trials to assess whether neurofeedback has a place in the treatment of AD. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups

    Directory of Open Access Journals (Sweden)

    Kamps Willem A

    2007-11-01

    Full Text Available Abstract Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17, 11 parents, and 18 survivors (aged 8–17 at diagnosis participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.

  18. Results of Nailfold Capillaroscopy in Patients with Normal-Tension Glaucoma.

    Science.gov (United States)

    Kosior-Jarecka, Ewa; Bartosińska, Joanna; Łukasik, Urszula; Wróbel-Dudzińska, Dominika; Krasowska, Dorota; Chodorowska, Grażyna; Żarnowski, Tomasz

    2018-06-01

    The aim of the study was to evaluate the results of nailfold videocapillaroscopic examination in patients with normal-tension glaucoma (NTG) in comparison to age-matched individuals without glaucoma and young healthy volunteers and to assess the relation between the results of this examination with clinical status in NTG group. The studied group consisted of 188 patients: 80 patients with NTG and 2 control groups (58 young healthy and 50 age-matched volunteers). The nailfold videocapillaroscopy (NVC) was performed in all participants. The results of every NVC were qualified as a normal or abnormal pattern. In the NTG group, ophthalmic examination was performed and medical history regarding glaucoma, chronic general disorders, and vascular risk factors was recorded. In the NTG group, an abnormal NVC pattern was more common than in young controls (p = 0.0008). Microbleedings were present more frequently in NTG patients (p = 0.0365). Enlargement of capillaries (p = 0.0006) and branching capillaries (p = 0.0221) were more frequent in the NTG group compared to age-matched controls. Maximal intraocular pressure was higher in NTG patients with abnormal NVC pattern than with normal NVC (p = 0.0000). Disc hemorrhages were more frequently observed in patients with abnormal NVC pattern (p = 0.0313). Presence of paracentral scotoma was associated with abnormal NVC pattern (p = 0.0054). Abnormalities in nailfold capillaroscopy are more frequent in NTG patients. The results of capillaroscopic examination differ in NTG patients according to the profile of ocular and general risk factor.

  19. [Functional results of Hirschsprung's disease patients after Duhamel and De la Torre procedures].

    Science.gov (United States)

    Fernández Ibieta, M; Sánchez Morote, J M; Martínez Castaño, I; Reyes Ríos, P; Cabrejos Perotti, K; Rojas Ticona, J; Ruiz Pruneda, R; Aranda García, M J; Roqués Serradilla, J L; Trujillo Ascanio, A; Hernández Bermejo, J P; Ruiz Jiménez, J I

    2013-10-01

    Long term results of different surgical techniques in Hirschsprung's Disease (HD) are contradictory. There are still no long term large or multicentric reports about functional results of De la Torre technique. We have studied the mid term functional results of the patients operated on Duhamel (D) and De la Torre (dlT) pull-through procedures. We collected data from medical records and telephone interviews of the HD patients operated in our unit in the last 16 years. 38 patients were found. Ages ranged from 1.5 to 21 years. Mean age was 7.7 years. Median follow up was 5.9 years. 33 (86.8%) had rectosigmoid disease and 5 (13.2%) had long segment disease. D procedure was performed in 17 (44.7%), Soave in 1 (2.6%), Duhamel-Lester-Martin in 4 (10.5%) and dlT pull-through in 16(42%). In the last visit record, 12 (31.6%), had constipation, and fecal leaks were noted in 11 (33.3%) of the 33 patients > or = 4 years old.. 10 patients (29.4% of the > or = 4 years old group) referred encopresis along the follow-up. Patients from the D group referred higher rates of constipation than those in the dlT group (53.3% vs 20% p=0.048). dlT patients referred more frequency of leaks (46,1% vs 13,3%, p=0,05) Children with very short resections (Encopresis was similar in all groups. Both techniques show similar functional results in the mid term, although children in the D group were more prone to constipation and those in the dlT group presented more fecal leaks. All patients with EH need long follow-ups.

  20. Histopathological Examination of Patients Operated on for a Neck Mass: 4-Year Follow-Up Results

    OpenAIRE

    Mahmut ÖZKIRIŞ; Mehtap KALA

    2011-01-01

    Objective: To investigate the diagnostic distribution of neck masses treated surgically at our clinic and also to discuss the clinical presentation and histological finding of these pathologies.Material and Method: We retrospectively reviewed the records (age, sex, clinical presentation and histological findings) of 201 patients who presented at our clinic with neck masses between 2006 and 2010.Results: Of the 201 patients, 98 (48.75%) were classified as inflammatory masses, 67 (33.33%) as ne...

  1. Systematic preservation of teeth and prophylaxis of dental decay on irradiated patients. Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Horiot, J C [Centre de Lutte contre le Cancer Georges-Francois-Leclerc, 21 - Dijon (France); Schraub, S [Centre Hospitalier Universitaire, 25 - Besancon (France)

    1975-11-01

    200 patients were irradiated on the oral cavity and on salivary glands with doses of 3,000 Rads and up. Teeth were preserved. A prophylactic treatment of dental decay was made using 5 minutes daily a fluoride gel into a carrier. The results showed an incidence of 5% for dental decay and 1% for osteo-radionecroses. Details are given about the selection of patients, the dental work-up and dental care before, during and after radiation therapy.

  2. Patient-oriented presentation of results of radiological procedures using DICOM-compliant DVD media

    Science.gov (United States)

    Ratib, Osman M.; Aberle, Denise R.; Goldin, Jonathan G.; Lu, David S.; Dahlbom, Magdalena; McGill, D. Ric; McCoy, J. Michael

    2003-05-01

    Some institutions have adopted digital media such as CD ROMs to provide patients and referring physicians with results of radiological procedures. These systems require a computer to review the images and lack the supporting explanations and guidance for patients to properly understand the results. We developed a hybrid DVD encoding format that combines DICOM-compliant image storage format with video streams viewable on any consumer DVD players. The addition of the video material allows radiologists to provide explanations, disclaimers and guidance to the patients regarding the results of the study. The diagnostic report is also included on the DVD as a PDF file and as a set of video frames that can be viewed on a DVD player. The native high-resolution images are also included in DICOM format on the DVD and can be accessed by any workstation equipped with a DICOM viewer. The DVD that can be reviewed on any consumer DVD player overcomes the limitation of CD ROMS that require the use of a personal computer. The results of the radiological procedures become more accessible patients that could be reluctant or unable to use a computer. Also, live video clips add a more personalized note and allow radiologists to convey important messages to the patients. This is particularly useful for self-referred screening procedures where results should always be accompanied with education material and explanations of the findings.

  3. Lynch syndrome patients' views of and preferences for return of results following whole exome sequencing.

    Science.gov (United States)

    Hitch, Kelly; Joseph, Galen; Guiltinan, Jenna; Kianmahd, Jessica; Youngblom, Janey; Blanco, Amie

    2014-08-01

    Whole exome sequencing (WES) uses next generation sequencing technology to provide information on nearly all functional, protein-coding regions in an individual's genome. Due to the vast amount of information and incidental findings that can be generated from this technology, patient preferences must be investigated to help clinicians consent and return results to patients. Patients (n = 19) who were previously clinically diagnosed with Lynch syndrome, but received uninformative negative Lynch syndrome genetic results through traditional molecular testing methods participated in semi-structured interviews after WES testing but before return of results to explore their views of WES and preferences for return of results. Analyses of interview results found that nearly all participants believed that the benefits of receiving all possible results generated from WES outweighed the undesirable effects. The majority of participants conveyed that relative to coping with a cancer diagnosis, information generated from WES would be manageable. Importantly, participants' experience with Lynch syndrome influenced their notions of genetic determinism, tolerance for uncertain results, and family communication plans. Participants would prefer to receive WES results in person from a genetic counselor or medical geneticist so that an expert could help explain the meaning and implications of the potentially large quantity and range of complicated results. These results underscore the need to study various populations with regard to the clinical use of WES in order to effectively and empathetically communicate the possible implications of this new technology and return results.

  4. Burden of heart failure on patients from China: results from a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Jackson JDS

    2018-06-01

    Full Text Available James DS Jackson,1 Sarah E Cotton,1 Sara Bruce Wirta,2 Catia C Proenca,3 Milun Zhang,4 Raquel Lahoz,5 Frederico J Calado5 1Real World Research, Adelphi Real World, Bollington, UK; 2Real World Evidence, Cardio-Metabolics Franchise, Novartis Sweden AB, Stockholm, Sweden; 3Wellmera AG, Basel, Switzerland; 4Health Economics and Outcomes Research and Access Strategy, Novartis Pharma China, Beijing, China; 5Real World Evidence, Cardio-Metabolics Franchise, Novartis Pharma AG, Basel, Switzerland Purpose: Little evidence exists on the burden that chronic heart failure (HF poses specifically to patients in China. The objective of this study, therefore, was to describe the burden of HF on patients in China.Materials and methods: A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient questionnaire.Results: Most of the 933 patients (mean [SD] age 65.8 [10.2] years; 55% male; 80% retired included in the study received care in tier 2 and 3 hospitals in large cities. Patients gave a median score of 4 on a scale from 1 (no disruption to 10 (severe disruption to describe how much HF disrupts their everyday life. Patients in paid employment (8% missed 10% of work time and experienced 29% impairment in their ability to work due to HF in the previous week. All aspects of patients’ health-related quality of life (QoL were negatively affected by their condition. Mean ± SD utility calculated by the 3-level 5-dimension EuroQol questionnaire was 0.8±0.2, and patients rated their health at 70.3 (11.5 on a 100 mm visual analog scale. Patients incurred costs associated with HF treatment, travel, and professional caregiving services.Conclusion: HF is associated with poor health-related QoL and considerable disruption in patients’ lives. Novel and improved therapies

  5. Results of surgical treatment of cervical cancer patients of childbearing age

    Directory of Open Access Journals (Sweden)

    V. S. Navruzova

    2015-01-01

    Full Text Available The world marked increase in the incidence of cervical cancer in young women, especially from 29 to 45 years old. Analysis showed that in patients with preserved ovarian function, not only the effectiveness of the treatment, but also the quality of life. It is associated with the acceleration, earlier puberty and the onset of sexual activity. In recent years more and more widely used radical surgery with preservation of the ovaries and the abduction of the radiation castration and preservation of reproductive function. In the National Cancer Research Centre of the Ministry of Health of the Republic of Uzbekistan analyzed the results of surgical treatment of 204 patients with cervical cancer younger. Age of patients from 23 to 45 years, that is, in the most hard-working, reproductive period. In our study patients met principally with exophytic – 82 (40.2 % and 68 (33.3 % еndophytic growth cervical tumors. Histological in 197 (96.6 % patients with squamous cervical cancer patients with 7 (3.4%. Adenocarcinoma of cervical cancer. Handard examination of the patient are further adapted to determine the level of sex hormones (estradiol, progesterone, determination of the tumor marter CA-125 levels of calcium and phosphate in the blood. 112 patients from the main group and the combined complex therapy surgical treatment with organ-component (conservation and ovarian transposition. The first group included 112 (55.1 % patients, who as part of combination therapy was performed and complex surgical treatment of ovarian transposition. The second group included 92 (44.9% patients who as part of combination therapy and complex surgery performed without ovarian transposition. Each group was divided into 3 subgroup included patients with stage process T1b–2aN0M0. Which performs the combined radiotherapy. The second subgroups included patients with stage process that runs systemic chemotherapy, surgery, combined radiotherapy. The third group included

  6. The use of DNA fingerprinting to resolve conflicting results in patients with suspected gastrointestinal malignancy.

    Science.gov (United States)

    Islam, Sameer; Miller, Ethan D; Patel, Neal; De Petris, Giovanni; Highsmith, Edward W; Fleischer, David E

    2013-03-01

    To underscore the utility of DNA fingerprinting for clarifying disparate results from endoscopic pathologic specimens. Occasionally, serially obtained gastrointestinal biopsies may yield inconsistent results. These discrepancies pose a dilemma for gastroenterologists and their patients, especially when malignancy is a consideration. Patients referred to our tertiary care center from outside institutions had undergone endoscopically obtained esophageal biopsies showing malignancy, verified by pathologists at both our site and from the referring center. Repeat endoscopic biopsies at our center did not show malignancy. To verify that different sets of biopsies came from the same patient, we performed a polymerase chain reaction-based analysis comparing the 2 specimens. This analysis, called DNA fingerprinting, can show a high degree of certainty whether 2 specimens came from the same patient. In each case, DNA fingerprinting verified a match, laying the groundwork for intervention. One patient underwent endoscopic radiofrequency ablation to the esophageal mucosa involved. Another underwent esophagectomy with partial gastrectomy. Both are doing well clinically and remain cancer-free on follow-up. DNA fingerprinting is a powerful and a relatively inexpensive tool. Usually, only small amounts of tissue are required, and even degraded or archival tissue is adequate. DNA fingerprinting can be an important tool in the gastroenterologist's arsenal to help clarify conflicting results, allowing the patient and physician to move forward with the management.

  7. Evaluation of Methacholine Challenge Test Results in Chronic Cough Patients Referring to Clinic of Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Derakhshan Deilami Gholamreza

    2009-10-01

    Full Text Available Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks, who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a

  8. Indications for and clinical procedures resulting from magnetic resonance imaging of the knee in older patients

    Science.gov (United States)

    Parent, Marc-Etienne; Vézina, François; Carrier, Nathalie; Masetto, Ariel

    2018-01-01

    Abstract Objective To analyze the indications for and clinical procedures resulting from knee magnetic resonance imaging (MRI) in older patients. Design We retrospectively analyzed 215 medical records of patients 50 years of age and older who had undergone a unilateral knee MRI in 2009. Setting Centre hospitalier universitaire de Sherbrooke in Quebec. Participants Patients 50 years of age and older who underwent a knee MRI in 2009. Main outcome measures The main outcome measure was an invasive procedure in the same knee that underwent an MRI. Medical charts were reviewed up to 2014 for patient characteristics, MRI indication, ordering physician specialty, radiography before MRI, MRI findings, and clinical procedures resulting from the MRI. Results The patients’ mean (SD) age was 60.6 (7.5) years. The main MRI indications were meniscopathy (148 [68.8%]) and chronic pain (92 [42.8%]). The main MRI findings were osteoarthritis (OA) (185 [86.0%]) and meniscal lesions (170 [79.1%]). Only 82 (38.1%) patients had a plain radiograph in the 24 months preceding the MRI, usually without a standing anteroposterior view. Findings on pre-MRI radiography (n = 201) demonstrated OA in 144 (71.6%) patients. Overall, 87 (40.5%) patients were seen by an orthopedic surgeon and 27 (31.0%) of these patients underwent an invasive intervention. Among the 81 patients with moderate to severe OA on MRI, 36 (44.4%) had radiographic evidence of moderate to severe OA and only 3 (3.7%) underwent arthroscopic meniscectomy. Conclusion Our study reproduces the known association between OA and degenerative meniscal changes in older patients. We have found a surprising underuse of the standing anteroposterior view on radiography. Most patients in our cohort could have been appropriately diagnosed and treated based on such radiographic information, as demonstrated by pre-MRI findings, thus avoiding the MRI and subsequent evaluation by an orthopedic surgeon. Meniscectomy was rarely performed

  9. Partner-Assisted Emotional Disclosure for Patients with GI Cancer: Results from a Randomized Controlled Trial

    Science.gov (United States)

    Porter, Laura S.; Keefe, Francis J.; Baucom, Donald H.; Hurwitz, Herbert; Moser, Barry; Patterson, Emily; Kim, Hong Jin

    2009-01-01

    Background For patients with cancer who are married or in an intimate relationship, their relationships with their partners play a critical role in their adaptation to their illness. However, cancer patients and their partners often have difficulty in talking with each other about their cancer-related concerns. Difficulties in communication may ultimately compromise both the patient-partner relationship and the patient's psychological adjustment. The present study tested the efficacy of a novel partner-assisted emotional disclosure intervention in a sample of patients with gastrointestinal (GI) cancer. Methods 130 patients with GI cancer and their partners were randomly assigned to receive four sessions of either partner-assisted emotional disclosure or a couples cancer education/support intervention. Patients and partners completed measures of relationship quality, intimacy with their partner, and psychological distress before randomization and at the end of the intervention sessions. Data were analyzed using multilevel modeling. Results Compared to an education/support condition, the partner-assisted emotional disclosure condition led to improvements in relationship quality and intimacy for couples in which the patient initially reported higher levels of holding back from discussing cancer-related concerns. Conclusions Partner-assisted emotional disclosure is a novel intervention that builds on both the private emotional disclosure and the cognitive-behavioral marital literature. The results of this study suggest that this intervention may be beneficial for couples in which the patient tends to hold back from discussing concerns. Future research on methods of enhancing the effects of partner-assisted emotional disclosure is warranted. PMID:19731357

  10. Percutaneous vertebroplasty: Multi-centric results from EVEREST experience in large cohort of patients

    Energy Technology Data Exchange (ETDEWEB)

    Anselmetti, Giovanni Carlo, E-mail: giovanni.anselmetti@ircc.it [Interventional Radiology Unit, Institute for Cancer Research and Treatment, Strada Provinciale No. 142, Km. 3, 95, 10060 Candiolo, Turin (Italy); Marcia, Stefano, E-mail: stemarcia@gmail.com [Radiology Unit, ASL8 Cagliari, SS. Trinità Hospital, Via Is Mirrionis 92, 09121 Cagliari (Italy); Saba, Luca, E-mail: lucasaba@tiscali.it [Radiology Unit, University of Cagliari, Policlinico Universitario, ss 554, Monserrato, 09127 Cagliari (Italy); Muto, Mario, E-mail: mutomar@tiscali.it [Neuroradiology Unit, AORN Cardarelli, Via A. Cardarelli No. 9, 80131 Napoli (Italy); Bonaldi, Giuseppe, E-mail: bonaldi@mail.org [Neuroradiology Unit, Riuniti di Bergamo, Largo Barozzi, 124128 Bergamo (Italy); Carpeggiani, Paolo, E-mail: p.carpeggiani@ausl.mo.it [Neuroradiology Unit, Policlinico di Modena, Via Dal Pozzo 17, Modena (Italy); Marini, Stefano, E-mail: stemarini@gmail.com [Radiology Unit, University of Cagliari, San Giovanni di Dio Hospital, Via Ospedale 46, 09127 Cagliari (Italy); Manca, Antonio, E-mail: anto.manca@gmail.com [Interventional Radiology Unit, Institute for Cancer Research and Treatment, Strada Provinciale No. 142, Km. 3, 95, 10060 Candiolo, Turin (Italy); Masala, Salvatore, E-mail: salva.masala@tiscali.it [Radiology Unit, Diagnostic Imaging Department, University of Rome Tor Vergata, Roma (Italy)

    2012-12-15

    Purpose: The purpose of this study was to prospectively evaluate results and complications of percutaneous vertebroplasty (PV) performed in 6 different Italian Centres belonging to the European VErtebroplasty RESearch Team (E.VE.RES.T) in a large series of patients. Materials and methods: Follow-up was obtained in 4547 patients (3211 females and 1336 males; mean age 70.2 years) that underwent PV for a total of 13.437 treated vertebrae. Procedures were performed by using fluoroscopic guidance or combined CT-fluoroscopic guidance. All patients underwent PV in local anaesthesia except for second cervical vertebrae treated with a trans-oral approach that required general anaesthesia. Results: 4004 out of 4547 (88.0%) patients reported significant pain relief (difference > or = 2 point in pain evaluated with an 11-point visual analogue scale; p < 0.0001) within 48 h: an average of 7.7 ± 0.4 dropped to 1.8 ± 0.6 in the osteoporotic patients; 8.3 ± 0.4 to 2.4 ± 0.4 in metastases; 8.3 ± 0.4 to 1.7 ± 1.0 in myeloma; 6.2 ± 3.5 to 0.3 ± 0.2 in angioma and 7.4 ± 0.4 to 1.4 ± 0.9 in trauma. 430 osteoporotic patients (13%) were retreated for a subsequent fracture; in 302/430 patients (70.2%), the new fracture occurred in the contiguous vertebra. No major neurologic complications were reported and the most frequent minor complication was venous leakage (20.5%). Conclusions: This large series of patients confirms that percutaneous vertebroplasty is an effective and safe procedure in the treatment of vertebral fractures. Best results are obtained in the treatment of myeloma and trauma.

  11. Reversible sympathetic vasomotor dysfunction in POTS patients.

    Science.gov (United States)

    Freitas, J; Santos, R; Azevedo, E; Costa, O; Carvalho, M; de Freitas, A F

    2000-11-01

    Orthostatic intolerance refers to the development upon assuming an upright posture of disabling symptoms, which are partly relieved by resuming the supine position. Postural tachycardia syndrome (POTS) is an orthostatic intolerance syndrome characterized by palpitations due to excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope. Patients usually undergo extensive medical, cardiac, endocrine, neurological and psychiatric evaluation, which usually fails to identify a specific abnormality. We investigated the autonomic and hemodynamic profile of POTS patients and the efficacy of bisoprolol and or fludrocortisone. We evaluated eleven female patients with POTS before and after medical treatment with a cardio-selective beta blocker (bisoprolol) and/or fludrocortisone, and eleven age-matched controls. Variability of heart rate and systolic blood pressure was assessed by Fast Fourier Transform, and spontaneous baroreceptor gain by temporal sequences slope and alpha index. Modelflow was used to quantify hemodynamics. All patients improved greatly after medication. The autonomic and hemodynamic impairment observed in patients with POTS, particularly after orthostatic stress, is treated effectively with bisoprolol and/or fludrocortisone. These results need further confirmation in a controlled double-blind study. Proper medical treatment dramatically improves the clinical and autonomic/hemodynamic disturbances observed in patients with POTS. The data support the hypothesis that POTS is due to a hyperadrenergic activation and/or hypovolemia during orthostasis.

  12. Results of remote follow-up and monitoring in young patients with cardiac implantable electronic devices.

    Science.gov (United States)

    Silvetti, Massimo S; Saputo, Fabio A; Palmieri, Rosalinda; Placidi, Silvia; Santucci, Lorenzo; Di Mambro, Corrado; Righi, Daniela; Drago, Fabrizio

    2016-01-01

    Remote monitoring is increasingly used in the follow-up of patients with cardiac implantable electronic devices. Data on paediatric populations are still lacking. The aim of our study was to follow-up young patients both in-hospital and remotely to enhance device surveillance. This is an observational registry collecting data on consecutive patients followed-up with the CareLink system. Inclusion criteria were a Medtronic device implanted and patient's willingness to receive CareLink. Patients were stratified according to age and presence of congenital/structural heart defects (CHD). A total of 221 patients with a device - 200 pacemakers, 19 implantable cardioverter defibrillators, and two loop recorders--were enrolled (median age of 17 years, range 1-40); 58% of patients were younger than 18 years of age and 73% had CHD. During a follow-up of 12 months (range 4-18), 1361 transmissions (8.9% unscheduled) were reviewed by technicians. Time for review was 6 ± 2 minutes (mean ± standard deviation). Missed transmissions were 10.1%. Events were documented in 45% of transmissions, with 2.7% yellow alerts and 0.6% red alerts sent by wireless devices. No significant differences were found in transmission results according to age or presence of CHD. Physicians reviewed 6.3% of transmissions, 29 patients were contacted by phone, and 12 patients underwent unscheduled in-hospital visits. The event recognition with remote monitoring occurred 76 days (range 16-150) earlier than the next scheduled in-office follow-up. Remote follow-up/monitoring with the CareLink system is useful to enhance device surveillance in young patients. The majority of events were not clinically relevant, and the remaining led to timely management of problems.

  13. [Advance Directives in Family Practices: Results of a Survey of GP Patients on their Care Situation].

    Science.gov (United States)

    Schnakenberg, Rieke; Just, Johannes; Thiessen, Vitali; Puth, Marie-Therese; Bleckwenn, Markus; Weckbecker, Klaus

    2017-07-26

    Background Advance directives (AD) are an important tool for documentation of patients' wishes and are therefore recommended to the elderly as well as patients with chronic diseases. However, there is no standardized procedure in Germany and no guideline for counseling patients who wish to write an AD with or without health care proxy. The aim of this study was to evaluate the care situation concerning the ADs and the role of the primary care physician in drafting the document Method We conducted semi-structured interviews with patients in primary care in North Rhine-Westphalia using a cross-sectional study design. Result Most of the 154 patients who were interviewed (average age: 58 years; 52% female) suffered from chronic diseases (79%), and about one-third (32%) already had an AD. Fear of "loss of autonomy" was the main reason for preparing an AD. Patients without AD were generally not opposed to the concept and named procrastination (43%) as the main reason for not having prepared one. The chance for preparing an AD increased by the factor 1.08 per life-year (Odds ratio (OR): 1.08; CI: 1.04-1.11). Patients with AD mostly got advice via the internet (22%), their primary care physicians (12%) and relatives (12%). Most patients were satisfied with their AD. Conclusion The majority of primary care patients do not make use of ADs. The primary care physicians play an important role in counseling and should motivate patients to complete ADs. Here, the establishment of quality standards would be desirable in the future. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Gamma Knife Radiosurgery for Patients With Nonfunctioning Pituitary Adenomas: Results From a 15-Year Experience

    International Nuclear Information System (INIS)

    Pollock, Bruce E.; Cochran, Joseph; Natt, Neena; Brown, Paul D.; Erickson, Dana; Link, Michael J.; Garces, Yolanda I.; Foote, Robert L.; Stafford, Scott L.; Schomberg, Paula J.

    2008-01-01

    Purpose: To evaluate the efficacy and complications of stereotactic radiosurgery for patients with nonfunctioning pituitary adenomas (NFA). Methods and Materials: This was a retrospective review of 62 patients with NFA undergoing radiosurgery between 1992 and 2004, of whom 59 (95%) underwent prior tumor resection. The median treatment volume was 4.0 cm 3 (range, 0.8-12.9). The median treatment dose to the tumor margin was 16 Gy (range, 11-20). The median maximum point dose to the optic apparatus was 9.5 Gy (range, 5.0-12.6). The median follow-up period after radiosurgery was 64 months (range, 23-161). Results: Tumor size decreased for 37 patients (60%) and remained unchanged for 23 patients (37%). Two patients (3%) had tumor growth outside the prescribed treatment volume and required additional treatment (fractionated radiation therapy, n = 1; repeat radiosurgery, n 1). Tumor growth control was 95% at 3 and 7 years after radiosurgery. Eleven (27%) of 41 patients with normal (n = 30) or partial (n = 11) anterior pituitary function before radiosurgery developed new deficits at a median of 24 months after radiosurgery. The risk of developing new anterior pituitary deficits at 5 years was 32%. The 5-year risk of developing new anterior pituitary deficits was 18% for patients with a tumor volume of ≤4.0 cm 3 compared with 58% for patients with a tumor volume >4.0 cm 3 (risk ratio 4.5; 95% confidence interval = 1.3-14.9, p = 0.02). No patient had a decline in visual function. Conclusions: Stereotactic radiosurgery is effective in the management of patients with residual or recurrent NFA, although longer follow-up is needed to evaluate long-term outcomes. The primary complication is hypopituitarism, and the risk of developing new anterior pituitary deficits correlates with the size of the irradiated tumor

  15. Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery.

    Science.gov (United States)

    İyigün, Taner; Kaya, Mehmet; Gülbeyaz, Sevil Özgül; Fıstıkçı, Nurhan; Uyanık, Gözde; Yılmaz, Bilge; Onan, Burak; Erkanlı, Korhan

    2017-03-01

    Patient-reported outcome measures reveal the quality of surgical care from the patient's perspective. We aimed to compare body image, self-esteem, hospital anxiety and depression, and cosmetic outcomes by using validated tools between patients undergoing robot-assisted surgery and those undergoing conventional open surgery. This single-center, multidisciplinary, randomized, prospective study of 62 patients who underwent cardiac surgery was conducted at Hospital from May 2013 to January 2015. The patients were divided into two groups: the robotic group (n = 33) and the open group (n = 29). The study employed five different tools to assess body image, self-esteem, and overall patient-rated scar satisfaction. There were statistically significant differences between the groups in terms of self-esteem scores (p = 0.038), body image scores (p = 0.026), overall Observer Scar Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p = 0.036) scores in favor of the robotic group during the postoperative period. Robot-assisted surgery protected the patient's body image and self-esteem, while conventional open surgery decreased these levels but without causing pathologies. Preoperative depression and anxiety level was reduced by both robot-assisted surgery and conventional open surgery. The groups did not significantly differ on Patient Satisfaction Scores and depression/anxiety scores. The results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Median of patient results as a tool for assessment of analytical stability

    DEFF Research Database (Denmark)

    Jørgensen, Lars Mønster; Hansen, Steen Ingemann; Petersen, Per Hyltoft

    2015-01-01

    BACKGROUND: In spite of the well-established external quality assessment and proficiency testing surveys of analytical quality performance in laboratory medicine, a simple tool to monitor the long-term analytical stability as a supplement to the internal control procedures is often needed. METHOD......: Patient data from daily internal control schemes was used for monthly appraisal of the analytical stability. This was accomplished by using the monthly medians of patient results to disclose deviations from analytical stability, and by comparing divergences with the quality specifications for allowable...... analytical bias based on biological variation. RESULTS: Seventy five percent of the twenty analytes achieved on two COBASs INTEGRA 800 instruments performed in accordance with the optimum and with the desirable specifications for bias. DISCUSSION: Patient results applied in analytical quality performance...

  17. Amnestic MCI Patients' Perspectives toward Disclosure of Amyloid PET Results in a Research Context.

    Science.gov (United States)

    Vanderschaeghe, Gwendolien; Schaeverbeke, Jolien; Vandenberghe, Rik; Dierickx, Kris

    2017-01-01

    Researchers currently are not obligated to share individual research results (IRR) with participants. This non-disclosure policy has been challenged on the basis of participants' rights to be aware and in control of their personal medical information. Here, we determined how patients view disclosure of research PET results of brain amyloid and why they believe it is advantageous or disadvantageous to disclose. As a part of a larger diagnostic trial, we conducted semi-structured interviews with patients with amnestic Mild Cognitive Impairment (aMCI). Participants had the option to receive their brain amyloid PET scan result (i.e., their IRR). Interviews were conducted before they received their IRR. A total of 38 aMCI patients (100% of study participants) wanted to know their IRR. The two most frequently mentioned reasons for choosing IRR disclosure were to better understand their brain health status and to be better able to make informed decisions about future personal arrangements (e.g., inheritance tax, moving into a smaller house, end-of-life decisions, etc.). Emotional risk was mentioned as the primary disadvantage of knowing one's IRR. On the other hand, non-disclosure was considered to be emotionally difficult also, as patients would be uncertain about their future health condition. Many patients diagnosed clinically with aMCI want to know their brain amyloid test results, even though this knowledge may be disadvantageous to them. Knowing what is going on with their health and the ability to make informed decisions about their future were the two principal advantages mentioned for obtaining their amyloid PET results. Because of the overwhelming consensus of aMCI patients was to disclose their brain amyloid PET scan results, researchers should strongly consider releasing this information to research subjects.

  18. Use of laboratory test results in patient management by clinicians in Malawi.

    Science.gov (United States)

    Moyo, Kundai; Porter, Carol; Chilima, Ben; Mwenda, Reuben; Kabue, Mark; Zungu, Lutho; Sarr, Abdoulaye

    2015-11-18

    Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment. To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. A cross-sectional study was conducted in 2012 to survey practising clinicians. Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these, 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%), followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility ( P management. Key informants reported that the quality of laboratory services was good and useful, but that services were often unavailable. Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain, reduce turn-around times, improve the test menu and improve the laboratory infrastructure.

  19. Behavioral economics holds potential to deliver better results for patients, insurers, and employers.

    Science.gov (United States)

    Loewenstein, George; Asch, David A; Volpp, Kevin G

    2013-07-01

    Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health. We show how these programs could be made more effective through the use of insights from behavioral economics. For example, incentive programs that offer patients small and frequent payments for behavior that would benefit the patients, such as medication adherence, can be more effective than programs with incentives that are far less visible because they are folded into a paycheck or used to reduce a monthly premium. Deploying more-nuanced insights from behavioral economics can lead to policies with the potential to increase patient engagement and deliver dividends for patients and favorable cost-effectiveness ratios for insurers, employers, and other relevant commercial entities.

  20. Midterm results of endovascular stent graft treatment for descending aortic aneurysms including high-risk patients

    Directory of Open Access Journals (Sweden)

    Gussmann, Andreas

    2006-04-01

    Full Text Available Methods: 21 patients (17 men, 4 women; mean age 66.1 years, range 29-90 years with 15 true aneurysms, and 6 type B-dissections were treated by implantation of a TalentTM Endoluminal Stentgraft System from February 2000 to July 2003. In 3 cases it was necessary to overstent the left subclavian artery, in 1 case to overstent the left common carotid. Results: 2 patients (9.5% died during the first 30 days (1 myocardial infarction, 1 pneumonia. Two patients (9.5% suffered from cerebral ischemia and needed revascularisation. No paraplegia, no stroke occurred. One endoleak required additional stenting. No patient needed conversion. Follow-up, average 25.4 months (range 0-39, was 100% complete. During this another two patients died of myocardial infarction i.e. 9.5% (the above mentioned endoleak, but no late migration were detected in the remaining patients. In all cases the graft lumen stayed patent. Conclusions: Treatment of descending thoracic aortic aneurysm with an endovascular approach has acceptable mortality and morbidity-rates even in high risk patients. Procedural overstenting of the subclavian artery requires subclavian revascularisation in a minority of cases.

  1. Radiofrequency ablation of hepatic metastasis: Results of treatment in forty patients

    Directory of Open Access Journals (Sweden)

    Rath G

    2008-01-01

    Full Text Available Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm. A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%. One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size.

  2. Results of radiotherapy in patients with stage I orbital non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Letschert, J.G.J.; Gonzalez Gonzalez, D.; Oskam, J.; Koornneef, L.; Dijk, J.D.P. van; Boukes, R.; Bras, J.

    1991-01-01

    The results of radiotherapy in early stage orbital non-Hodgkin's lymphoma are described. From 1970-1985, 33 orbital localizations in 30 patients were treated. Total dose applied ranged from 21-57 Gy (2 Gy/fraction), 2/3 off all patients received a 40 Gy dose. Complete response rate was 94% and 10 years actuarial survival was 90%; between patients with low grade or intermediate grade lymphoma no significant difference in survival was observed. No local recurrence was detected during follow up and 20% of the patients developed generalized disease. Two optic nerve neuropathies and 3 retinopathies were observed in 5 patients, 4 of these occurred at a dose level of less than 43 Gy. Keratitis occurred in 58% of the patients treated, a sicca syndrome in 30% and cataract of different grades in 58%. Although local control was excellent, severe complications were observed in 13% of the patients who received a dose of less than 43 Gy. (author). 35 refs., 4 figs., 5 tabs

  3. Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients.

    Science.gov (United States)

    Jarrah, Mohamad; Hammoudeh, Ayman J; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Okkeh, Osama; Alhaddad, Imad A; Tawalbeh, Loai Issa; Hweidi, Issa M

    2018-04-01

    Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight. Obese patients were more likely to be female and to have a higher prevalence of diabetes, hypertension, hypercholesterolemia, or previous percutaneous coronary intervention. Acute coronary syndrome was the indication for percutaneous coronary intervention in 77.0% of obese, 76.4% of overweight, and 77.4% of normal/underweight patients. No significant differences in the prevalence of multi-vessel coronary artery disease or multi-vessel percutaneous coronary intervention were found among the three groups. Additionally, no significant differences were found in stent thrombosis, readmission bleeding rates, or cardiac mortality among the three groups during hospitalization, at 1 month, and at 1 year. Conclusion The major adverse cardiovascular event rate was the same among the three groups throughout the study period. Accordingly, body mass index is considered a weak risk factor for cardiovascular comorbidities in Arab Jordanian patients.

  4. Correlation between MRI results and intraoperative findings in patients with silicone breast implants.

    Science.gov (United States)

    Lindenblatt, Nicole; El-Rabadi, Karem; Helbich, Thomas H; Czembirek, Heinrich; Deutinger, Maria; Benditte-Klepetko, Heike

    2014-01-01

    Silicone gel breast implants may silently rupture without detection. This has been the main reason for magnetic resonance imaging (MRI) of the augmented or reconstructed breast. The aim of the present study was to investigate the accuracy of MRI for implant rupture. Fifty consecutive patients with 85 silicone gel implants were included in the study. The mean age of the patients was 51 (range 21-72) years, with a mean duration of implantation of 3.8 (range 1-28) years. All patients underwent clinical examination and breast MRI. Intraoperative implant rupture was diagnosed by the operating surgeon. Nineteen of the 50 patients suffered from clinical symptoms. An implant rupture was diagnosed by MRI in 22 of 85 implants (26%). In seven of 17 removed implants (41%), the intraoperative diagnosis corresponded with the positive MRI result. However, only 57% of these patients were symptomatic. Ultrasound imaging of the harvested implants showed signs of interrupted inner layers of the implant despite integrity of the outer shell. By microsurgical separation of the different layers of the implant shell, we were able to reproduce this phenomenon and to produce signs of implant rupture on MRI. Our results show that rupture of only the inner layers of the implant shell with integrity of the outer shell leads to a misdiagnosis on MRI. Correlation with clinical symptoms and the specific wishes of the patient should guide the indication for implant removal.

  5. Hereditary hemorrhagic telangiectasia in children: endovascular treatment of neurovascular malformations. Results in 31 patients

    International Nuclear Information System (INIS)

    Krings, T.; Chng, S.M.; Ozanne, A.; Alvarez, H.; Lasjaunias, P.L.; Rodesch, G.

    2005-01-01

    Hereditary hemorrhagic telangiectasia (HHT) is a heterogeneous disease that can present with a variety of clinical manifestations. The neurovascular complications of this disease, especially in children, may be potentially devastating. The purpose of this article was to review the therapeutic results of endovascular treatment of neurovascular malformations in children. A total of 31 patients under the age of 16 were included in this retrospective analysis. All children were treated in a single center. Twenty children presented with 28 arteriovenous (AV) fistulae, including seven children with spinal AV fistulae and 14 children with cerebral AV fistulae (one child had both a spinal and cerebral fistulae). Eleven children had small nidus-type AV malformations. All embolizations were performed employing superselective glue injection. Follow-up ranged between 3 and 168 months (mean 66 months). A total of 115 feeding vessels were embolized in 81 single sessions, resulting in a mean overall occlusion rate of the malformation of 77.4% (ranging from 30 to 100%). Two of 31 patients (6.5%) died as a direct complication of the embolization procedure; two patients (6.5%) had a persistent new neurological deficit; eight patients (26.7%) were clinically unchanged following the procedure; in 13 patients (41.9%) an amelioration of symptoms but no cure could be achieved; and six patients (19.4%) were completely asymptomatic following the endovascular procedure. (orig.)

  6. Long-term results of radiotherapy for 104 patients with Graves' orbitopathy

    International Nuclear Information System (INIS)

    Qu Baolin; Yang Dong; Feng Linchun; Luo Zhiyuan

    2008-01-01

    Objective: To evaluate the long-term outcome and the sequelae of Graves' orbitopathy treated with radiotherapy, and to specify the prognostic factors. Methods: From 1979 to 1999, 104 patients with progressive Graves' orbitopathy were treated with conventional orbital radiotherapy. Post globe and pituitary irradiation of 25-35 Gy was given to 56 patients, which was followed by a boost of 15-20 Gy to the pituitary. Follow-up time was 7.5 - 25.0 years. The result of radiotherapy was analyzed. Results: Overall response rate was 71.1%. The response rate of patients with soft-tissue infiltration, corneal involvement, proptosis, sight loss and extraocular muscle dysfunction was 88.4%, 75.1%, 55.6%, 68.8% and 64.4%, respectively. Twelve patients (11.5%) developed cataracts 2.5-18.3 years (median 11.2 years) after irradiation. One patient developed left-eye retinopathy 3.2 years after irradiation. No patient developed secondary tumor within the irradiation field. Conclusions: Orbital radiotherapy for progressive Graves' orbitopathy, being effective and safe, can control the disease progression and improve the symptoms. The side effect of radiotherapy is fewer than other treatment modalities. (authors)

  7. Long Term Results of Visual Field Progression Analysis in Open Angle Glaucoma Patients Under Treatment.

    Science.gov (United States)

    Kocatürk, Tolga; Bekmez, Sinan; Katrancı, Merve; Çakmak, Harun; Dayanır, Volkan

    2015-01-01

    To evaluate visual field progression with trend and event analysis in open angle glaucoma patients under treatment. Fifteen year follow-up results of 408 eyes of 217 glaucoma patients who were followed at Adnan Menderes University, Department of Ophthalmology between 1998 and 2013 were analyzed retrospectively. Visual field data were collected for Mean Deviation (MD), Visual Field Index (VFI), and event occurrence. There were 146 primary open-angle glaucoma (POAG), 123 pseudoexfoliative glaucoma (XFG) and 139 normal tension glaucoma (NTG) eyes. MD showed significant change in all diagnostic groups (pfield indices. We herein report our fifteen year follow-up results in open angle glaucoma.

  8. Long-term results of irradiation for patients with progressive GRAVES' ophthalmopathy

    International Nuclear Information System (INIS)

    Marquez, Sheri D.; Lum, Bert L.; McDougall, I. Ross; Katkuri, Shobha; Levin, Peter S.; MacManus, Michael; Donaldson, Sarah S.

    2001-01-01

    Purpose: To determine the long-term outcome of radiotherapy (RT) in patients with progressively symptomatic thyroid eye disease and to evaluate the potential long-term sequelae. Methods and Materials: Four hundred fifty-three patients provided written informed consent and received retrobulbar RT for Graves' ophthalmopathy at Stanford University Medical Center; 197 with ≥1 year of follow-up were retrospectively analyzed. Of the 197 patients, 189 received RT to the bilateral retrobulbar regions, and 4 received unilateral RT. The technical information was unavailable for 4 patients. Patients were assessed by chart review, telephone interview, questionnaire, and multidisciplinary physician examination. Eye impairment was scored using the SPECS system. The end point review included the before and after treatment SPECS score, surgical intervention, and patient satisfaction. Potential complications, including cataract development, retinopathy, and tumor formation, were investigated. Multivariate analyses were performed to assess the prognostic variables. Results: Improvement or resolution was 89% for soft-tissue findings; 70% for proptosis; 85% for extraocular muscle dysfunction; 96% for corneal abnormalities; and 67% for sight loss. The response to RT may take >6 months to stabilize. Factors predictive of response varied in the individual SPECS categories but included the initial SPECS score, pretreatment thyroid status, female gender, a 20-Gy RT dose, and a history of hypertension. Nonpredictive factors included a history of tobacco use, diabetes mellitus, steroids, and prior cataracts. Only 16% required surgical intervention to preserve their vision or restore binocular vision. Twenty-two patients (12%) developed cataracts after irradiation (median 11 years). No patient developed a tumor within the RT field during the follow-up period (range 1-29 years). Ninety-eight percent of patients were pleased with their results, and 2% believed their symptoms progressed

  9. Natural history and surgical results in patients with unruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    Okiyama, Koichi; Nagano, Osamu; Machida, Toshio; Serizawa, Toru; Ono, Junichi; Higuchi, Yoshinori

    2008-01-01

    The management of patients with unruptured intracranial aneurysms (UIAs) is controversial. We aimed to assess the natural history of UIAs and evaluate the surgical results. We analyzed 154 patients (181 saccular UIAs) with no history of subarachnoid hemorrhage (SAH) from a different aneurysm. Aneurysms were detected by magnetic resonance angiography (MRA) or by 3-dimensional CT angiography. Although the most frequent reason for the diagnosis was routine brain examinations of healthy patients or a vague symptom such as headache or dizziness, 15 patients were symptomatic. The natural history in patients who did not have surgery (follow-up group: 76 cases, 95 aneurysms) was assessed, and the surgical outcome of UIAs (surgical group: 78 cases, 86 aneurysms) was evaluated. Among 76 patients in the follow-up group, 7 had SAH. The mean latency period to aneurysm rupture was 3.2 months. The aneurysms with subsequent bleeding ranged from 5 to 25 mm (19.3 mm on average), whereas those without ranged from 1 to 28 mm (4.5 mm on average). The rupture rates of UIAs in anterior and posterior circulation were 6.2% and 14.3%, respectively. All ruptured cases were females. Mortality and morbidity associated with UIAs in the follow-up group were 3.9% and 3.9%, respectively. In the surgical group, no mortality was noted. Permanent morbidity associated with prospective repair of UIAs was 5.1%, although the morbidity of the patients with preoperative Rankin scores of 0 or 1 was 1.3%. Transient morbidity was observed in 6 patients (7.7%) with the size of the aneurysm 19.8 mm on average. The natural history and surgical results in patients with UIAs are modified by several factors including aneurysm size and location, the patient's age and gender, the medical status and the patient's preoperative Rankin score. The present results indicated that these factors should be considered in deciding whether to treat UIAs, and that careful assessment of the surgical benefits might be essential

  10. Results of open heart surgery in Jehovah's Witness patients. Single centre experience.

    Science.gov (United States)

    Juraszek, Andrzej; Kołsut, Piotr; Szymański, Jarosław; Kuriata, Jarosław; Kuśmierski, Krzysztof; Sitkowska-Rysiak, Ewa; Jasińska, Małgorzata; Kuśmierczyk, Mariusz

    2017-09-01

    Evaluation the results in patients from the religious community of Jehovah's Witness (JW) undergoing open heart surgery at our institution. Between September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

  11. Optimizing time management after perforation by colonoscopy results in better outcome for the patients.

    Science.gov (United States)

    Rumstadt, Bernhard; Schilling, Dieter

    2008-01-01

    Perforation during colonoscopy is a rare but severe complication. The aim of this study was to assess the time management and laparoscopic therapy of this complication and to evaluate patient outcomes. A retrospective analysis was done on 15 patients operated for a perforation from colonoscopy between January 2000 and December 2006. Three perforations occurred during diagnostic and 12 perforations during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in 4 cases and significantly correlated with the mean time between perforation and operation. Twelve perforations were oversewn laparoscopically and 3 perforations were oversewn by laparotomy. After laparoscopic treatment, hospital stay was significantly shorter than after laparotomy. One patient had a postoperative wound infection, mortality was 0%. Laparoscopic oversewing is a safe and effective method in the treatment of perforation from colonoscopy. Optimizing the time range between perforation and laparoscopic therapy results in a better outcome for the patients.

  12. Long-term Results of the Patients with Regional Transient Osteoporosis

    Directory of Open Access Journals (Sweden)

    Kenan Akgün

    2002-09-01

    Full Text Available Transient regional osteoporosis is an uncommon cause of hip pain. It affects mostly healthy middle-aged men, and women in the third trimester of pregnancy. The aetiology is unknown. Eight patients (3 females, 5males who were diagnosed as transient regional osteoporosis of hip were included in the study. Long-term results of all the patients were evaluated. Their mean follow-up duration was 5.1 years. Following every hip involvement, after a mean duration of 6.6 months, all the patients were asymptomatic and returned to full activitiy without residual effects. Both hips were affected in 5 patients, in 4 of which the involvement was migratory. Migratory involvement duration ranged from 3 months to 4 years. In conclusion, Transient regional osteoporosis is self-limiting and resolves symptomatically and radiologically within some months of presentation.

  13. Abnormal computerized dynamic posturography findings in dizzy patients with normal ENG results.

    Science.gov (United States)

    Sataloff, Robert T; Hawkshaw, Mary J; Mandel, Heidi; Zwislewski, Amy B; Armour, Jonathan; Mandel, Steven

    2005-04-01

    The complexities of the balance system create difficulties for professionals interested in testing equilibrium function objectively. Traditionally, electronystagmography (ENG) has been used for this purpose, but it provides information on only a limited portion of the equilibrium system. Computerized dynamic posturography (CDP) is less specific than ENG, but it provides more global insight into a patient's ability to maintain equilibrium under more challenging environmental circumstances. CD Palso appears to be valuable in obtaining objective confirmation of an abnormality in some dizzy patients whose ENG findings are normal. Our review of 33 patients with normal ENG results and abnormal CDP findings suggests that posturography is useful for confirming or quantifying a balance abnormality in some patients whose complaints cannot be confirmed by other tests frequently used by otologists.

  14. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten

    2006-01-01

    the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. Results Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers....... Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type...... 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient–provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent...

  15. Results of conservative, surgical treatment and rehabilitation of entrapment neuropathies in elderly patients in geriatric practice

    Directory of Open Access Journals (Sweden)

    Jadwiga Główczewska

    2017-03-01

    Full Text Available Entrapment neuropahies of upper limbs can cause mainly nocturnal neuropathic pain and impaired manual dexterity. The most common entrapment neuropathy is carpal tunnel syndrome and ulnar groove syndrome - ulnar nerve entrapment at the elbow. Treatment of entrapment neuropathies is both analgetic therapy and physiotherapy. In the cases of conservative treatment inefficiencies surgical decompression of nerves is performed. Authors of this oublication present results of both conservative  and surgical of entrapment neuropathies in patients over 65 years old. Among the 17 patients with entraoment neuropathies 12 of them underwent surgical treatment. Achieved partial improvement in pain, mostly nocturnal and improving the quality of life and dexterity. In comparison, however, a group of younger patients who underwent surgery for the improvement was less spectacular, which may testify advancement and irreversibility of changes in older patients.

  16. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Kjel [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: kjel_andersen@web.de; Hennersdorf, Marcus [Department of Cardiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: hennersdorf@med.uni-duesseldorf.de; Cohnen, Mathias [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: cohnen@med.uni-duesseldorf.de; Blondin, Dirk [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Moedder, Ulrich [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: moedder@uni-duesseldorf.de; Poll, Ludger W. [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: poll@gmx.de

    2009-07-15

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  17. Aortic valve-sparing in 37 patients with Marfan syndrome: midterm results with David operation.

    Science.gov (United States)

    Forteza, Alberto; De Diego, Javier; Centeno, Jorge; López, Maria Jesus; Pérez, Enrique; Martín, Carlos; Sánchez, Violeta; Rufilanchas, Juan J; Cortina, Jose

    2010-01-01

    We reviewed our experience with aortic valve-sparing operations in Marfan syndrome during last 5 years. Between March 2004 and June 2009, 94 patients with aortic root aneurysms underwent valve-sparing operations. Of these, 37 (68% male) were diagnosed with Marfan syndrome, according to the Ghent diagnostic criteria. Mean age was 30 +/- 10 years (range, 11 to 59 years). Moderate/severe aortic regurgitation was present in 13%, and the mean diameter of the Valsalva sinuses was 50 +/- 4 mm (range, 42 to 62 mm). The David V modification was performed in the last 28 patients. Additional procedures were mitral valve repair in 6, tricuspid valve repair in 3, closure of septal atrial defect in 2, and closure of a patent foramen ovale in 13. Mean follow-up was 27 +/- 16 months (range, 1 to 61 months). There were no in-hospital deaths and no major adverse outcomes. One patient required implantation of a mechanical prosthesis during the same procedure because of moderate aortic regurgitation. One late death occurred. No patients required reoperation. In the last follow-up, 23 patients did not have aortic regurgitation, 12 had grade I, and 1 had grade II. No thromboembolic complications have been documented, and 97% of the patients are free from anticoagulation. Short-term and midterm results with the reimplantation technique for aortic root aneurysms in Marfan patients are excellent. If long-term results are similar, this technique could be the treatment of choice for these patients. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey.

    Directory of Open Access Journals (Sweden)

    Jördis M Zill

    Full Text Available Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1 validate, and 2 prioritize these dimensions.A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1 give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2 add missing dimensions, and 3 prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria.105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median ≥ 7 on both criteria (relevance and clarity. Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment.11 out of the 15 dimensions have been validated through experts' ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

  19. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    International Nuclear Information System (INIS)

    Andersen, Kjel; Hennersdorf, Marcus; Cohnen, Mathias; Blondin, Dirk; Moedder, Ulrich; Poll, Ludger W.

    2009-01-01

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  20. Valuation of transfusion-free living in MDS: results of health utility interviews with patients

    Directory of Open Access Journals (Sweden)

    Lübbert Michael

    2009-09-01

    Full Text Available Abstract Background This study measured how myelodysplastic syndrome (MDS patients value transfusion independence (TI, reduced transfusions (RT and transfusion-dependence (TD using health utility assessment methodology. Methods 47 MDS patients were interviewed, US (n = 8, France (n = 9, Germany (n = 9 and the UK (n = 21, to elicit the utility value of TI, RT and TD. Health states were developed based on literature; patient forum discussions; and were validated by a hematologist. Face-to-face interviews used the feeling thermometer Visual Analogue Scale (VAS and the Time Trade-Off (TTO method to value the health states on a 0 (dead to 1 (perfect health scale. Socio-demographic, clinical, and quality-of-life (EQ-5D characteristics were surveyed to describe the patient sample. Results and Discussion The mean age was 67 years (range: 29-83; 45% male, 70% retired; 40% had secondary/high school education, or higher (32%, and 79% lived with family, a partner or spouse, or friends. The mean time from MDS diagnosis was 5 years (range:1-23. Most patients (87% received previous transfusions and 49% had received a transfusion in the last 3 months. Mean EQ-5D index score was 0.78; patients reported at least some problem with mobility (45%, usual activities (40%, pain/discomfort (47%, and anxiety/depression (34%. Few patients had difficulty understanding the VAS (n = 3 and TTO (n = 4 exercises. Utility scores for TI were higher than for RT (0.84 vs. 0.77; p Conclusion Patients value TI, suggesting an important role for new treatments aiming to achieve greater TI in MDS. These results can be used in preference-based health economic evaluation of new MDS treatments, such as in future cost-utility studies.

  1. Determinants of persistence in hypertensive patients treated with irbesartan: results of a postmarketing survey

    Directory of Open Access Journals (Sweden)

    Greminger Peter

    2005-06-01

    Full Text Available Abstract Background Persistence is a key factor for long-term blood pressure control, which is of high prognostic importance for patients at increased cardiovascular risk. Here we present the results of a post-marketing survey including 4769 hypertensive patients treated with irbesartan in 886 general practices in Switzerland. The goal of this survey was to evaluate the tolerance and the blood pressure lowering effect of irbesartan as well as the factors affecting persistence in a large unselected population. Methods Prospective observational survey conducted in general practices in all regions of Switzerland. Previously untreated and uncontrolled pre-treated patients were started with a daily dose of 150 mg irbesartan and followed up to 6 months. Results After an observation time slightly exceeding 4 months, the average reduction in systolic and diastolic blood pressure was 20 (95% confidence interval (CI -19.6 to -20.7 mmHg and 12 mmHg (95% CI -11.4 to -12.1 mmHg, respectively. At this time, 26% of patients had a blood pressure Conclusion The results of this survey confirm that irbesartan is effective, well tolerated and well accepted by patients, as indicated by the good persistence. This post-marketing survey also emphasizes the importance of the tolerability profile and of achieving an early control of blood pressure as positive predictors of persistence.

  2. Prostate alpha/beta revisited - an analysis of clinical results from 14 168 patients

    Energy Technology Data Exchange (ETDEWEB)

    Dasu, Alexandru [Dept. of Radiation Physics UHL, County Council of Oestergoetland, Linkoeping (Sweden); Radiation Physics, Dept. of Medical and Health Sciences, Faculty of Health Sciences, Linkoeping Univ., Linkoeping (Sweden); Toma-Dasu, Iuliana [Medical Radiation Physics, Stockholm Univ. and Karolinska Institutet, Stockholm (Sweden)

    2012-11-15

    Purpose. To determine the dose response parameters and the fractionation sensitivity of prostate tumours from clinical results of patients treated with external beam radiotherapy. Material and methods. The study was based on five-year biochemical results from 14 168 patients treated with external beam radiotherapy. Treatment data from 11 330 patients treated with conventional fractionation have been corrected for overall treatment time and fitted with a logit equation. The results have been used to determine the optimum {alpha}/{beta} values that minimise differences in predictions from 2838 patients treated with hypofractionated schedules. Results. Conventional fractionation data yielded logit dose response parameters for all risk groups and for all definitions of biochemical failures. The analysis of hypofractionation data led to very low {alpha}/{beta} values (1-1.7 Gy) in all mentioned cases. Neglecting the correction for overall treatment time has little impact on the derivation of {alpha}/{beta} values for prostate cancers. Conclusions. These results indicate that the high fractionation sensitivity is an intrinsic property of prostate carcinomas and they support the use of hypofractionation to increase the therapeutic gain for these tumours.

  3. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty (Turkey)

    2012-08-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  4. Partner-assisted emotional disclosure for patients with gastrointestinal cancer: results from a randomized controlled trial.

    Science.gov (United States)

    Porter, Laura S; Keefe, Francis J; Baucom, Donald H; Hurwitz, Herbert; Moser, Barry; Patterson, Emily; Kim, Hong Jin

    2009-09-15

    For patients with cancer who are married or in an intimate relationship, their relationships with their partners play a critical role in their adaptation to illness. However, cancer patients and their partners often have difficulty in talking with each other about their cancer-related concerns. Difficulties in communication ultimately may compromise both the patient-partner relationship and the patient's psychological adjustment. The current study tested the efficacy of a novel partner-assisted emotional disclosure intervention in a sample of patients with gastrointestinal (GI) cancer. One hundred thirty patients with GI cancer and their partners were assigned randomly to receive 4 sessions of either partner-assisted emotional disclosure or a couples cancer education/support intervention. Patients and partners completed measures of relationship quality, intimacy with their partner, and psychological distress before randomization and at the end of the intervention sessions. Data were analyzed using multilevel modeling. Compared with an education/support condition, the partner-assisted emotional disclosure condition led to improvements in relationship quality and intimacy for couples in which the patient initially reported higher levels of holding back from discussing cancer-related concerns. Partner-assisted emotional disclosure is a novel intervention that builds on both the private emotional disclosure and the cognitive-behavioral marital literature. The results of this study suggested that this intervention may be beneficial for couples in which the patient tends to hold back from discussing concerns. The authors concluded that future research on methods of enhancing the effects of partner-assisted emotional disclosure is warranted. Copyright (c) 2009 American Cancer Society.

  5. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    International Nuclear Information System (INIS)

    Ozcan, Nevzat; Kahriman, Guven; Mavili, Ertugrul

    2012-01-01

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14–92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  6. Are Italian medical societies bridging the distance from citizen and patients' associations? Results of a survey.

    Science.gov (United States)

    Mosconi, P; Colombo, C; Guella, F; Pierotti, B; Vimercati, F

    2008-09-01

    In the framework of PartecipaSalute--an Italian research project aimed to involve lay people, patients' associations and scientific-medical representatives on the health debate --we carried out a survey with the Italian Federation of Medical Societies. The aims of the survey were to know medical societies attitude vs. patients involvement in research activities and healthcare setting and to find out possible projects conducted in partnership with patients associations. A web-questionnaire with 17 closed questions, and three open questions has been prepared on the basis of some experiences published on the literature and through the collaboration of members of the Italian Federation of Medical Societies. A total of 205 medical societies has been contacted by e-mail with a cover letter explaining the aims of the survey. At the end 74 medical societies completed the survey. Medical societies participating to the survey varied widely in terms of years of activity, number of members, and geographical distribution. Remarkably, 36 medical societies respondent organized collaborative initiatives with patients/consumers associations during the last three years. Among these, the most frequent were the preparation of written material for patients, organization of conferences or workshops, and health awareness campaigns. Moreover, 6 medical societies published documents on patients' rights but patients or their associations were involved in only 2 of these initiatives. Advantages and disadvantages reported by medical societies answering are also presented and discussed. In conclusion, to our knowledge this is the first survey on the value of patients' involvement conducted together with medical societies in Italy, and the results point the way to stronger collaboration in future between patients' associations and medical societies.

  7. [Posterosuperior impingement of the shoulder in the athlete: results of arthroscopic debridement in 75 patients].

    Science.gov (United States)

    Riand, N; Boulahia, A; Walch, G

    2002-02-01

    patients were very satisfied, 22 were satisfied and 45 were disappointed. Twelve patients had resumed their sports activities at their former level with loaded arm movement and one patient had interrupted all sports activities. At last follow-up, 22 patient had undergone another surgical procedure: 20 derotation osteotomies of the humerus, one anterior stabilization, one acromioplasty. The notion of posterosuperior impingement is increasingly recognized as the cause of pain in thrower athletes. Loaded arm movements produce a physiological contact between the posteriorsuperior edge of the glenoid cavity and the deep aspect of the rotator cuff. Injury results from repeated loaded arm movements in throwers. In our series, all the patients had at least one lesion, either involving the cuff or the labrum. According to the Snyder classification, 80% of the supraspinatus lesions were grade 1 or grade 2. We did not have any full thickness tears. All patients with a normal cuff were found to have a lesion of the posterosuperior labrum. At arthroscopy, dynamic assessment evidenced an impingement between the supraspinatus (or the infraspinatus) and the labrum or the bony edge of the glenoid cavity. Only three patients had a labral lesion anterior to the biceps insertion that could be considered a type 1 or 2 slap lesion. Unlike earlier reports by others, we had disappointing results after debridement: 60% of the patients were disappointed after the procedure and only 40% were satisfied (22 patients) or very satisfied (8 patients). Patient satisfaction depended greatly on the level of sports activity attained after arthroscopy, the eight very satisfied patients had resumed their former level. None of the professional athletes or those competing at the international level were very satisfied with arthroscopic debridement. There was an inverse relationship between level of competition and patient satisfaction after debridement.

  8. Comparison of abdominopelvic CT results and findings at second-look laparotomy in ovarian carcinoma patients

    International Nuclear Information System (INIS)

    Reuter, K.L.; Griffin, T.; Hunter, R.E.

    1987-01-01

    Restaging in epithelial ovarian carcinoma after primary therapy has proven difficult by standard noninvasive methods and commonly requires second-look laparotomy. In the authors' study to date preoperative abdominopelvic CT (CBT) results and operative findings have been compared in 24 patients (25 studies) with ovarian adenocarcinoma currently clinically free of disease originally graded as FIGO stage III or IV, except for one patient with stage IC, undergoing second-look laparotomy to determine tumor status. There were ten true-negative, three false-negative, 12 true-positive, and no false-positive CBTs. Negative studies were associated with positive findings at laparotomy, including microscopic foci, in only 12% of all cases; thus, CBT in the series has shown a better correlation with surgery than in previous studies. Currently the authors are combining monoclonal antibody scanning with the CBT results with the goal of possibly avoiding second-look surgery in certain patients

  9. Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme

    Energy Technology Data Exchange (ETDEWEB)

    Gamper, Eva-Maria [Medical University Innsbruck, Department for Nuclear Medicine, Innsbruck (Austria); Medical University Innsbruck, Department for Psychiatry and Psychotherapy, Innsbruck (Austria); Wintner, Lisa M.; Holzner, Bernhard [Medical University Innsbruck, Department for Psychiatry and Psychotherapy, Innsbruck (Austria); Rodrigues, Margarida; Buxbaum, Sabine; Nilica, Bernhard; Virgolini, Irene [Medical University Innsbruck, Department for Nuclear Medicine, Innsbruck (Austria); Singer, Susanne [University of Mainz, Institute of Medical Biostatistics, Epidemiology, and Informatics, Mainz (Germany); Giesinger, Johannes M. [Netherlands Cancer Institute, Amsterdam (Netherlands)

    2015-07-15

    Health-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL. We analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients' baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage. A total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6 % women; 80.7 % papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9 % women; 76.3 % papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample. Our results show that

  10. Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme

    International Nuclear Information System (INIS)

    Gamper, Eva-Maria; Wintner, Lisa M.; Holzner, Bernhard; Rodrigues, Margarida; Buxbaum, Sabine; Nilica, Bernhard; Virgolini, Irene; Singer, Susanne; Giesinger, Johannes M.

    2015-01-01

    Health-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL. We analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients' baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage. A total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6 % women; 80.7 % papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9 % women; 76.3 % papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample. Our results show that

  11. Results of salvage radiotherapy after inadequate surgery in invasive cervical carcinoma patients: A retrospective analysis

    International Nuclear Information System (INIS)

    Saibishkumar, Elantholi P.; Patel, Firuza D.; Ghoshal, Sushmita; Kumar, Vinay; Karunanidhi, Gunaseelan; Sharma, Suresh C.

    2005-01-01

    Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix. Methods and Materials: Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions. Results: The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, disease-free survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine. Conclusions: Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity

  12. The results of palliative radiation therapy in patients with unresectable advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Ryu, Mi Ryeong; Yoon, Sei Chul; Kim, Yeon Sil; Chung, Su Mi

    2006-01-01

    To evaluate the treatment results and prognostic factors of palliative radiation therapy in the patients with unresectable advanced pancreatic cancer. Thirty-seven evaluable patients with unresectable advanced pancreatic cancer who were treated by palliative radiation therapy for pain relief at the Department of Radiation Oncology, Kangnam St. Mary's hospital, the Catholic University of Korea between March 1984 and February 2005 were analysed retrospectively. There were 22 men and 15 women. Age at diagnosis ranged from 30 to 80 (median 57) years. Twelve patients (32.4%) had liver metastases and 22 patients (59.5%) had lymph node metastases. Radiation therapy was delivered to primary tumor and regional lymph nodes with 1 ∼ 2 cm margin, and total dose was 3,240 ∼ 5,580 cGy (median 5,040 cGy). Chemotherapy with radiotherapy was delivered in 30 patients (81%) with 5-FU alone (21 patients) or gemcitabine (9 patients). The follow-up period ranged from 1 to 44 months. Survival and prognostic factors were analysed using Kaplan-Meier method and log-rank test respectively. Overall mean and median survival were 11 and 8 months and 1-year survival rate was 20%. Among 33 patients who were amenable for response evaluation, 7 patients had good response and 22 patients had fail response with overall response rate of 87.9%. Mild to moderate toxicity were observed in 14 patients with nausea, vomiting, and indigestion, but severe toxicity requiring interruption of treatment were not observed. Chemotherapy didn't influence the survival and symptomatic palliation, but the group containing gemcitabine showed a tendency of longer survival (median 12 months) than 5-FU alone group (median 5.5 months) without statistical significance (ρ > 0.05). The significant prognostic factors were Karnofsky performance status and liver metastasis (ρ 0.05). Radiation therapy was effective for symptomatic palliation in the patients with unresectable advanced pancreatic cancer and would play an

  13. Assessment of reproductive results of infertile patients who had undergone operative hysteroscopy for intrauterine pathology

    Directory of Open Access Journals (Sweden)

    Röyale Seferli

    2015-03-01

    Full Text Available Objectives: We aimed to evaluate the reproductive outcomes of infertile patients who had undergone operative hysteroscopy (HS with the diagnoses of uterine septum, endometrial polyp, submucous myoma, and intrauterine adhesion. Methods: This retrospective study included 334 patients who had been diagnosed with primary and secondary infertility, aged between 18–35 years and diagnosed with uterine septum (group 1, endometrial polyp (group 2, submucous myoma (group 3, and intrauterine adhesion (group 4 by hysterosalpingography or office HS and who were treated via hysteroscopic operation between January 2009 and January 2013. Pregnancy results were obtained from the patients’ files and hospital database; when this was not possible, the patients were queried by phone calls. Groups were then compared in terms of characteristics, prognoses, and pregnancy outcomes. Results: The cumulative pregnancy rate was 58.7% in infertile patients who underwent operative HS due to intrauterine pathology. The mean length of time from operation to conception was 10.8±9.6 months in all groups. Mean age, infertility duration, infertility type, and smoking status were statistically different among the groups (p<0.05. Following surgery, 95 (66.4% of 143 patients in group 1 conceived and 57 (60% of these pregnancies resulted in term birth. There were 64 (54.2% pregnancies in group 2 and 34 (53.1% resulted in term birth. Sixteen (47.1% patients conceived in group 3, and 6 (37.5% of them had term birth. Twenty-one (53.8% patients conceived in group 4. Twelve out of 21 patients (57.1% had term birth. The most common mode of delivery was cesarean section in all groups. Conclusion: Thus, operative HS increases pregnancy rates in patients with intrauterine pathology. In future, large-scale prospective studies should be carried out to reveal the effects of the hysteroscopic method and compare this approach with other methods in order to achieve better pregnancy outcomes in

  14. Short-term Results of Vagus Nerve Stimulation in Pediatric Patients with Refractory Epilepsy

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    Chih-Yi Chen

    2012-06-01

    Conclusion: The effective management of medically intractable seizure remains challenging to most clinical physicians. In addition to ketogenic diet and epilepsy surgery, VNS provides an alternative way to manage this issue. Our results suggest that VNS is well tolerated in pediatric patients, and is a favorable and safe method of treating intractable seizure in common clinical practice.

  15. Initial results of combined anterior mitral leaflet extension and myectomy in patients with obstructive hypertrophic cardiomyopathy

    NARCIS (Netherlands)

    M.J.M. Kofflard (Marcel); L.A. van Herwerden (Lex); D.J. Waldstein; P.N. Ruygrok (Peter); H. Boersma (Eric); M.A. Taams (Meindert); F.J. ten Cate (Folkert)

    1996-01-01

    textabstractObjectives. The purpose of this study was to describe the clinical and functional results of combined anterior mitral leaflet extension and myectomy in patients with hypertrophic obstructive cardiomyopathy. Background. Septal myectomy is the most commonly performed surgical procedure in

  16. Relationship between the sensation of activity limitation and the results of functional assessment in asthma patients.

    Science.gov (United States)

    Vermeulen, Francois; Chirumberro, Audrey; Rummens, Peter; Bruyneel, Marie; Ninane, Vincent

    2017-08-01

    In asthma patients, the assessment of activity limitation is based on questions evaluating how limited the patient feels in their activities. However, the lack of functional data complicates the interpretation of the answers. We aimed to evaluate the intensity of relationships between the patient's perception of activity limitation and the results of several functional tests. Twenty patients complaining of asthma exacerbation were invited to complete three scores (Chronic Respiratory Disease questionnaire, Asthma Control Questionnaire, Hospital Anxiety and Depression scale). They also underwent lung function measurements, a 6-minute walk test and a cardio-pulmonary exercise test. In addition, physical activity was studied by actigraphy. Spearman's rank correlation coefficients between the patient's perception of activity limitation and each of the other parameters were analysed. Five parameters were significantly correlated with the perception of activity limitation: ACQ question 4, related to dyspnea (rs 0.74, p perception of activity limitation. In response to questions about limitation of activity, patients do not specifically answer mentioning physical limitation but rather the psychological burden associated with this constraint.

  17. THE STUDY OF RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH VERTEBRAL-SPINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    B. Sh. Minasov

    2010-01-01

    Full Text Available A study of the efficacy of medical rehabilitation of 170 patients with spinal-cord injury through the application of modern rehabilitation and surgical technologies was conducted. Patients of I (control group received standard set of conservative treatment and rehabilitation. Patients of II (main group the rehabilitation was supplemented with therapeutic exercises with the use of loop complex «Hope» and the rate of adaptation to the stress of hypoxia in the late period of injury. Patient of III (control group surgical treatment and the conventional range of rehabilitation were performed. Patients of IV (main group the rehabilitation was completed with early activation using espandernogo complex «Hope» and the rate of adaptation to the stress of hypoxia in the late period of injury. It is proved that the developed complex rehabilitation of patients with spinal-cord injury using an early stable functional osteosynthesis with the minimum extent necessary, the use of complex «Hope» can improve the functional results at the expense of early motor activation, preventing the formation of contractures and muscle atrophy. The use of adaptation to the stress of hypoxia in the late period of vertebro-spinal cord injury improves overall health, reduces the severity of autonomic reactions, emotional stress, can cut pain syndromes.

  18. Novel silicone stent to treat tracheobronchial lesions: results of 35 patients.

    Science.gov (United States)

    Saueressig, Maurício G; Sanches, Paulo R S; Macedo Neto, Amarilio V; Moreschi, Alexandre H; Oliveira, Hugo G; Xavier, Rogerio G

    2010-12-01

    We describe a case series of 35 patients with either benign (14) or malignant (21) tracheal stenosis who were treated using a novel silicone stent, the HCPA-1, designed to prevent migration. Between March 2001 and September 2008, 13 women and 22 men received 41 HCPA-1 stents. The median duration of stenting in benign cases was 457 days (range, 4-2,961 days). Successful stent removal with curative results was accomplished in 2 patients with tracheomalacia and 1 with post-intubation stenosis. In malignant cases, the median duration of stenting was 162 days (range, 1-1,279 days). Five patients had tumor progression with obstruction requiring repeated laser resection, dilatation, or additional stents. Two patients died due to airway obstruction despite bronchoscopic intervention. Twelve patients with malignant lesions died with the stent in place. At the end of the study, 3 patients with malignant disease remained alive; 2 were lost to follow-up. The HCPA-1 stent proved to be safe, with no severe complications during the study period, and effective in improving quality of life with relief of dyspnea.

  19. HISTOPLASMIN SURVEY IN HIV-POSITIVE PATIENTS: RESULTS FROM AN ENDEMIC AREA IN NORTHEASTERN BRAZIL

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    Fabricia Salvador Bezerra

    2013-07-01

    Full Text Available SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in Ceará, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of Ceará. Methods. Intradermal tests with histoplasmin (mycelial phase were performed in 161 HIV patients with CD4 ≥ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040 and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045 or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033 were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma.

  20. ACTIVITIES RESULTS AIMED AT IMPROVED MEDICAL ASSISTANCE TO THE VASCULAR PATIENTS IN TOMSK REGION

    Directory of Open Access Journals (Sweden)

    D. M. Plotnikov

    2013-01-01

    Full Text Available Acute disorders of cerebral circulation remain serious medical and social problem associated with high disability and mortality rates. Since 2011 Tomsk oblast is a participating member of the medical campaign aimed at improved medical services to the vascular patients. The preliminary implementation data analysis for 2012 revealed improvement of most of the indices of medical support to patients suffering from acute cerebral circulation; increased number of the in-patient cases (Regional Vascular Center and primary vascular department, decreased lethality rates from strokes, specifically hemorrhagic cases. Strict observance of the Regulations on Medical Assistance for stroke patients and the using of modern methods of therapy allowed to decrease hospital mortality in the Primary Vascular Departments and early mortality in the Regional Vascular Center. The active implementation of neurorehabilitation approaches resulted in the increased number of patients who do not require third parties’ assistance. Analysis of the work of the departments helped to identifying current problems and perspectives of further development of special medical care for stroke patients.

  1. Amnestic MCI Patients? Perspectives toward Disclosure of Amyloid PET Results in a Research Context

    OpenAIRE

    Vanderschaeghe, Gwendolien; Schaeverbeke, Jolien; Vandenberghe, Rik; Dierickx, Kris

    2017-01-01

    Background Researchers currently are not obligated to share individual research results (IRR) with participants. This non-disclosure policy has been challenged on the basis of participants? rights to be aware and in control of their personal medical information. Here, we determined how patients view disclosure of research PET results of brain amyloid and why they believe it is advantageous or disadvantageous to disclose. Method As a part of a larger diagnostic trial, we conducted semi-structu...

  2. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Sarac A

    2014-04-01

    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  3. Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

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    R. M. Tikhilov

    2014-01-01

    Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

  4. Long-term results of Heller myotomy without an antireflux procedure in achalasic patients.

    Science.gov (United States)

    Cortesini, Camillo; Cianchi, Fabio; Pucciani, Filippo

    2002-01-01

    Both open and laparoscopic myotomies have been used in the treatment of achalasia. Postoperative gastro-oesophageal reflux is among the commonly reported side effects of myotomy. The addition of an antireflux procedure to the standard surgical approach has given rise to controversy. The objective of our study was to determine whether or not an antireflux procedure should be used in addition to Heller myotomy. Over the period from 1980 to 1990, 94 patients (mean age: 47.9 years) with achalasia underwent Heller myotomy calibrated by intraoperative oesophageal manometry without fundoplication. In 1999-2000, all patients filled in a clinical questionnaire: all underwent radiographic oesophageal imaging, oesophageal manometry, ambulatory 24-h oesophageal pH monitoring, and oesophagogastroduodenoscopy, when necessary. Ten healthy age-matched subjects were compared in the manometric and radiological studies. Myotomy improved the clinical profiles and instrumental data results in all patients. Gastro-oesophageal reflux was present in 10 patients (10.6%); none of these 10 subjects presented oesophagitis. Heller open myotomy yields good long-term results. Intraoperative manometric calibration reduces the side effects of myotomy, such as gastro-oesophageal reflux. The addition of fundoplication is not justified in all patients.

  5. PRELIMINARY CLINICAL RESULTS WITH LIPOASPIRATE STROMAL VASCULAR CELL FRACTION IN TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    E. Ya. Shevela

    2017-01-01

    Full Text Available The paper presents results of clinical application of autologous stromal-vascular fraction (SVF cells in patients with degenerative osteoarthritis (OA of the knee, grade II and III (Kellgren–Lawrence scale.We recruited six patients with knee OA (3 men and 3 women; median age 64 years with mean disease duration of 7 years. All the patients were administered a single intra-articular injection of autologous nucleated SVF cells at an average dose of 16.8±0.9 × 106 per joint (a total of 11 joints. The patients did not experience any serious side effects (allergic, toxic or inflammatory related to the knee injection. Patient surveys at 1 month after SVF administration revealed a decrease in the severity of pain, as measured by a visual analog scale (VAS and a specialized 100-point scale KOOS (subscale "pain" (p < 0.05 on both scales. Moreover, the patients reported improvement in the joint functions and quality of life related to affected joints on a KOOS scale (p < 0.05. These positive clinical changes persisted during 6 month follow up. Significant improvements were noted in ultrasound findings, with increased thickness of the cartilage layer at 3 months (in 73% of cases and at 6 months (in 82%. Our pilot study demonstrated the safety and tolerability of intra-articular injection of autologous SVF cells in patients with moderate to severe OA. The results obtained also indicate a significant antiinflammatory effect of autologous adipose tissue SVF cells, which is manifested at the early stages of cell therapy. Our further investigations will be focused on exploring the SVF stimulatory effects on regeneration of damaged joints.

  6. Imaging of patients with hippocampal sclerosis at 7 Tesla: initial results.

    Science.gov (United States)

    Breyer, Tobias; Wanke, Isabel; Maderwald, Stefan; Woermann, Friedrich G; Kraff, Oliver; Theysohn, Jens M; Ebner, Alois; Forsting, Michael; Ladd, Mark E; Schlamann, Marc

    2010-04-01

    Focal epilepsies potentially can be cured by neurosurgery; other treatment options usually remain symptomatic. High-resolution magnetic resonance (MR) imaging is the central imaging strategy in the evaluation of focal epilepsy. The most common substrate of temporal epilepsies is hippocampal sclerosis (HS), which cannot always be sufficiently characterized with current MR field strengths. Therefore, the purpose of our study was to demonstrate the feasibility of high-resolution MR imaging at 7 Tesla in patients with focal epilepsy resulting from a HS and to improve image resolution at 7 Tesla in patients with HS. Six patients with known HS were investigated with T1-, T2-, T2(*)-, and fluid-attenuated inversion recovery-weighted sequences at 7 Tesla with an eight-channel transmit-receive head coil. Total imaging time did not exceed 90 minutes per patient. High-resolution imaging at 7 Tesla is feasible and reveals high resolution of intrahippocampal structures in vivo. HS was confirmed in all patients. The maximum non-interpolated in-plane resolution reached 0.2 x 0.2 mm(2) in T2(*)-weighted images. The increased susceptibility effects at 7 Tesla revealed identification of intrahippocampal structures in more detail than at 1.5 Tesla, but otherwise led to stronger artifacts. Imaging revealed regional differences in hippocampal atrophy between patients. The scan volume was limited because of specific absorption rate restrictions, scanning time was reasonable. High-resolution imaging at 7 Tesla is promising in presurgical epilepsy imaging. "New" contrasts may further improve detection of even very small intrahippocampal structural changes. Therefore, further investigations will be necessary to demonstrate the potential benefit for presurgical selection of patients with various lesion patterns in mesial temporal epilepsies resulting from a unilateral HS. Copyright 2010 AUR. Published by Elsevier Inc. All rights reserved.

  7. [An exploratory study of 'blended' cognitive behavioural therapy (CBT) for patients with a panic disorder: results and patients' experiences].

    Science.gov (United States)

    Bruinsma, A; Kampman, M; Exterkate, C C; Hendriks, G J

    2016-01-01

    Digital technology (e-health or 'blended' care), combined with evidence-based face-to-face CBT, is becoming increasingly implemented into mental health care and is expected to result in improved effectiveness and efficiency. To explore the feasibility of blended CBT for patients with a panic disorder. Nine face-to-face sessions of blended CBT (n = 18), supplemented with the digital support of a tabletcomputer and three e-mail contacts, were compared with 12 weekly sessions of regular CBT (n = 18). Primary outcomes were panic frequency and avoidance behaviour; the secondary outcome was general functioning. Patients' experiences of the treatment were collected in the form of a structured interview. The effect sizes found in both the regular and the blended CBT were medium to high (Cohen's d 0.42-1.60). In both types of treatment there was a significant reduction in patients' symptoms. There were no big differences in patient satisfaction regarding the treatment received. The therapists registered 39 face-to-face minutes in the blended treatment but they registered in total 41 fewer face-to-face minutes; this represented a time reduction of 4%. Blended CBT with help of a tablet computer seems to be a suitable method for treating panic disorder psychologically, although the time saved is only moderate. Much more research is needed to ascertain the feasibility and the cost effectiveness of blended CBT.

  8. Results of the safety and efficacy of iobitridol in more than 61,000 patients

    International Nuclear Information System (INIS)

    Petersein, J.; Peters, C.R.; Wolf, M.; Hamm, B.

    2003-01-01

    We present results of a postmarketing surveillance study with iobitridol (Xenetix, Sulzbach, Germany) in more than 61,000 patients from 1996 until 2000. The purpose of this study was the assessment of safety and diagnostic efficacy of the non-ionic contrast agent iobitridol in the setting of a post-marketing surveillance study. Iobitridol (Xenetix) has been registered in Germany since 1996. Between 1996 and 2000 207 radiologists have documented in a questionnaire the routine use of Xenetix in 61,754 patients that have received Xenetix for diagnostic procedures. On each questionnaire parameters regarding demographic data, safety, and diagnostic efficacy were assessed. The data were statistically evaluated and analysed. The examination allowed for a diagnosis in 99% of cases. Image quality was rated as ''excellent'' or ''good'' in 89.8% of cases. In obese patients there was a significantly higher percentage (p<0.001) of poor image quality. In 0.1% poor contrast was noted. Of patients, 28.8% had at least one risk factor, and 3.1% had three or more. Adverse events were noted in 2.3% of the examinations, but nearly half of them (1.1%) presented with ''feeling of warmth'' as the only symptom. Of adverse events, 0.2% were non-transient, and 1 patient died. In 0.2% of patients the procedure was stopped due to adverse events. In 0.9% of patients the causal relationship with the contrast agent was rated as probable (probable+possible=1.1%). The percentage of adverse events (excluding warmth) was independent of iodine concentration and of dose, and was higher in young patients. Xenetix is an efficient contrast agent for radiological procedures and is associated with a low rate of adverse events. (orig.)

  9. Skin prick test results in patients with atopic symptoms in Yozgat district

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    Emine Çölgeçen

    2014-03-01

    Full Text Available Objective: Skin prick test (SPT is used widely and fastly to determine the allergens in atopic disease. We aimed in this study to analysis the relationship between total serum IgE (T.IgE and allergens that found by SPT and looking over the frequency of allergens. Methods: We evaluated clinical findings and SPT results and T.IgE levels of 190 patients who admitted to dermatology outpatient clinic, retrospectively. Rsults: 53 (27.9% patients had idiopathic generalized pruritus (IGP, 41 (21.6% had atopic dermatitis (AD, 40 (21.1% had chronic idiopathic urticaria (CIU, 38 (20% had allergic rhinitis (AR, and 18 (9.5% had allergic asthma (AA. 123 (64.7% patients had positive reaction to at least one or more allergen on SPT. Of these patients 28 were IGP, 30 were AD, 20 were CIU, 28 were AR, and 17 were AA. The most common allergens were pine pollen (25.3%, wheat pollen (18.4%, and dog epithelium (15.8%. The mean levels of T.IgE was 382.61 ± 517.28 IU/ml (1-2500. T.IgE is higher 54.9% of patients. It was seen that DPT positivity was significantly more frequent in patients with increased T.IgE levels than those with normal total serum IgE level (p<0.05. Conclusion: We think that pine tree and wheat pollens are the most commonly encountered allergens at Yozgat area. Moreover, our findings indicated to the requirement and benefits of DPT in patients with AD, AR and AA in addition to the those KİU and İJP, particularly in patients with increased T.IgE levels, although further studies with larger sample size are needed. J Clin Exp Invest 2014; 5 (1: 64-68

  10. Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results

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    Galanakis, Nikolaos [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Kontopodis, Nikolaos [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Peteinarakis, Ioannis; Kehagias, Elias [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Ioannou, Christos V. [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Tsetis, Dimitrios, E-mail: tsetis@med.uoc.gr [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece)

    2017-02-15

    PurposeThe purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).Materials and MethodsBetween January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1–72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.ResultsTechnical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.ConclusionsDirect stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.Level of EvidenceLevel 4, Case Series.

  11. Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results

    International Nuclear Information System (INIS)

    Galanakis, Nikolaos; Kontopodis, Nikolaos; Peteinarakis, Ioannis; Kehagias, Elias; Ioannou, Christos V.; Tsetis, Dimitrios

    2017-01-01

    PurposeThe purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).Materials and MethodsBetween January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1–72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.ResultsTechnical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.ConclusionsDirect stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.Level of EvidenceLevel 4, Case Series.

  12. Patients' Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study.

    Science.gov (United States)

    Black, Georgia; Sheringham, Jessica; Spencer-Hughes, Vicki; Ridge, Melanie; Lyons, Mairead; Williams, Charlotte; Fulop, Naomi; Pritchard-Jones, Kathy

    2015-01-01

    Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emergency presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in an iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients' (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients' capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek

  13. Communicating patient-reported outcome scores using graphic formats: results from a mixed-methods evaluation.

    Science.gov (United States)

    Brundage, Michael D; Smith, Katherine C; Little, Emily A; Bantug, Elissa T; Snyder, Claire F

    2015-10-01

    Patient-reported outcomes (PROs) promote patient-centered care by using PRO research results ("group-level data") to inform decision making and by monitoring individual patient's PROs ("individual-level data") to inform care. We investigated the interpretability of current PRO data presentation formats. This cross-sectional mixed-methods study randomized purposively sampled cancer patients and clinicians to evaluate six group-data or four individual-data formats. A self-directed exercise assessed participants' interpretation accuracy and ratings of ease-of-understanding and usefulness (0 = least to 10 = most) of each format. Semi-structured qualitative interviews explored helpful and confusing format attributes. We reached thematic saturation with 50 patients (44 % < college graduate) and 20 clinicians. For group-level data, patients rated simple line graphs highest for ease-of-understanding and usefulness (median 8.0; 33 % selected for easiest to understand/most useful) and clinicians rated simple line graphs highest for ease-of-understanding and usefulness (median 9.0, 8.5) but most often selected line graphs with confidence limits or norms (30 % for each format for easiest to understand/most useful). Qualitative results support that clinicians value confidence intervals, norms, and p values, but patients find them confusing. For individual-level data, both patients and clinicians rated line graphs highest for ease-of-understanding (median 8.0 patients, 8.5 clinicians) and usefulness (median 8.0, 9.0) and selected them as easiest to understand (50, 70 %) and most useful (62, 80 %). The qualitative interviews supported highlighting scores requiring clinical attention and providing reference values. This study has identified preferences and opportunities for improving on current formats for PRO presentation and will inform development of best practices for PRO presentation. Both patients and clinicians prefer line graphs across group-level data and individual

  14. IMPROVING THE RESULTS OF TREATMENT OF PATIENTS WITH URETERAL CONCREMENTS AFTER CONTACT URETEROLITHOTRIPSY

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    R. M. Solh

    2017-01-01

    Full Text Available Purpose. Im proving the results of treatment of patients with ureteral stones and reducing the dam aging effects of contact lithotripsy.Materials and methods. In this study, 48 patients were examined aged 20 to 63 years. All patients admitted to the urology department with diagnoses: urolithiasis, calculus of the ureter. In all cases contact ureterolithotripsy with stenting of the upper urinary tract were performed. The patients were divided into two groups: main and control. 25 patients (52 .1% were included into the main group, which in the postoperative period, we used low-level laser therapy (L-therapy. 23 patients were included in a control group (47.9% who did not receive low-laser therapy. Laboratory tests and ultrasound with Doppler renal blood vessels scan were performed on admission, on the first day after the operation and on the 5-th day of hospitalization. Low-intensity laser therapy was performed within 5 days after contact ureterolithotripsy on projection of placement of stone and kidney projection by series for 5 minutes.Results. All patients admitted to the hospital, were spared from ureteral stones. In the main group during the treatment with L-therapy a decrease in the level of beta-2 microglobulin to normal was observed. (4.8 ± 0.1 mg/l on the first day. On the 5th day 2 .3 + 0.1 mg/l. In the control group during the treatment without the use of L-therapy, the average level of beta-2 microglobulin decreased but did not reach normal levels. (5.5 ± 0.1 mg/l on the first day. On the 5th day 3,2 ±0, l mg/l.Resistance index in the study group decreased compared to the control. In the control group, cases of acute pyelonephritis were observed. The average hospital stay for patients of the main group (6 days was less than in the control group (6 .5 + days.Conclusion. The use of laser therapy in the treatment of patients who did undergo ureterolithotripsy can reduce the length of stay of the patient in the hospital and reduce the

  15. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Science.gov (United States)

    Martens, Leon; Goode, Grahame; Wold, Johan F H; Beck, Lionel; Martin, Georgina; Perings, Christian; Stolt, Pelle; Baggerman, Lucas

    2014-01-01

    To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines. Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four. With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests. Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  16. Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

    Directory of Open Access Journals (Sweden)

    Leon Martens

    Full Text Available To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1 Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2 Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3 Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048 and a 75% increase in diagnostic yield (p = 0.007. There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

  17. Effect of demographic factors on brachytherapy treatment results in patients with endometrial cancer 1995-2010.

    Science.gov (United States)

    Jurczyk, Mieczysława U; Chmaj-Wierzchowska, Karolina; Klofik, Joanna; Sajdak, Stefan; Opala, Tomasz

    2013-01-01

    Approximately 1 in 20 female cancers in Europe is of the endometrium. Endometrial carcinoma is the most common gynaecologic cancer. Considering the fact that an upward tendency has recently been observed in morbidity due to this type of cancer, this is a serious medical problem. The presented report describes the results of the analysis of selected demographic factors and their effect on the incidence of endometrial cancer. Analysis of the results of treatment of endometrial cancer during 1995-2010 was also an objective of the study. Based on medical records obtained from the HDR Laboratory of Brachytherapy at the Gynaecological & Obstetrics Clinical Hospital, University of Medical Sciences in Poznań, the results of treatment of patients with endometrial cancer by brachytherapy were analyzed. The analysis covered a group of 400 patients. More than a half of the patients completed their education on the level of elementary or secondary school. Taking into consideration the weight of the patients, it appeared that most women had excessive body weight. Most frequently, concomitant hypertension was observed. Moreover, the age at menarche was 12 and 13. Demographic factors exert a significant effect on the incidence of endometrial cancer. 1. Overweight and obesity are important risk factors of endometrial cancer. 2. A strong relationship is observed between the occurrence of hypertension or diabetes, and the development of endometrial cancer. 3. Women who come from the rural environment and continue to live in this environment are more likely to contract endometrial cancer.

  18. Conservative surgery and radiotherapy in the treatment of breast cancer. Preliminary results of 148 patients

    International Nuclear Information System (INIS)

    Faria, S.L.; Chiminazzo Junior, H.; Koseki, N.; Oliveira Filho, J.A. de

    1986-01-01

    The combination of tumoral resection and radiotherapy with preservation of the breast is called conservative treatment of breast cancer. The literature considers this treatment a good option if used by an experient team and with appropriate equipment. This paper shows the results of 148 cases of breast cancer treated by this conservative approach at Centro de Oncologia Campinas. Follow-up varied from 3 to 87 months (mean 28) considered by the histological diagnosis. Overall actuarial survival of 5 years was 77% disease-free survival 55%. Twelve patients (8%) presented local relapse and 13 (9%) had distant metastases as the first therapeutic failure. Cosmetic results were considered good and fair in 89% of patients. These results are similar to others published in the literature (Author) [pt

  19. Phenotype in patients with intellectual disability and pathological results in array CGH.

    Science.gov (United States)

    Caballero Pérez, V; López Pisón, F J; Miramar Gallart, M D; González Álvarez, A; García Jiménez, M C; García Iñiguez, J P; Orden Rueda, C; Gil Hernández, I; Fuertes Rodrigo, C; Fernando Martínez, R; Rodríguez Valle, A; Alcaine Villarroya, M J

    Global developmental delay (GDD) and intellectual disability (ID) are frequent reasons for consultation in paediatric neurology departments. Nowadays, array comparative genomic hybridisation (array-CGH) is one of the most widely used techniques for diagnosing these disorders. Our purpose was to determine the phenotypic features associated with pathological results in this genetic test. We conducted a blind study of the epidemiological, clinical, anthropometric, and morphological features of 80 patients with unexplained ID to determine which features were associated with pathological results in array-CGH. Pathological results were found in 27.5% of the patients. Factors associated with pathological results in array-CGH were a family history of GDD/ID (OR = 12.1), congenital malformations (OR = 5.33), having more than 3 facial dysmorphic features (OR = 20.9), and hypotonia (OR = 3.25). Our findings are consistent with those reported by other published series. We therefore conclude that the probability of having pathological results in array-CGH increases with the presence of any of the features mentioned above in patients with ID/GDD. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Analysis of spirometry results in hospitalized patients aged over 65 years

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    Wróblewska I

    2015-06-01

    Full Text Available Izabela Wróblewska,1 Piotr Oleśniewicz,2 Donata Kurpas,3 Mariusz Sołtysik,2 Jerzy Błaszczuk41Faculty of Health Science, Wroclaw Medical University, 2Institute of Tourism and Recreation, University School of Physical Education in Wroclaw, 3Department of Family Medicine, 4Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Lower Silesia, PolandIntroduction and objective: The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged ≥65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders.Material and methods: In the research, 217 (100% patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro–Wilk test, the ANOVA test, and the Scheffé’s test were applied.Results: The majority of the patients (59.4% were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%. The study showed a statistically significant dependence between the forced vital capacity (FVC, forced expiratory volume in 1 second (FEV1, and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive

  1. Long-term results in patients with low-grade nodular non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Aviles, A.; Diaz-Maqueo, J.C.; Sanchez, E.; Cortes, H.D.; Ayala, J.R.; Oncology Hospital, Mexico City; National Medical Center, Mexico City

    1991-01-01

    One hundred and eighteen patients with nodular non-Hodgkin's lymphoma were randomized to receive either chemotherapy alone or chemotherapy plus radiotherapy (total nodal or involved field irradiation). Although the complete remission rate was similar in the three programs (about 90%) the relapse-free survival rate (RFS) among patients with complete remission was significantly higher in the groups treated with chemotherapy plus radiotherapy than among those treated with chemotherapy alone. The 7-year RFS in the groups treated with total node irradiation and involved field irradiation was 71% and 66% respectively, compared to only 33% in the group treated by chemotherapy alone (p<0.01). The results suggest that combined chemoradiotherapy may achieve complete long-term remission and potential cure in more than 60% of patients with nodular low-grade non-Hodgkin's lymphoma. Toxicity was moderate in all three arms. Bulky disease and a high level of lactic dehydrogenase were associated with a poor prognosis. (orig.)

  2. 131I therapy of teen-age hyperthyroidism: the primary results in 46 patients

    International Nuclear Information System (INIS)

    Wang Kaiming

    2001-01-01

    Objective: To explore various conditions of teen-age hyperthyroidism with 131 I therapy. Methods: 46 patients were administrated with 131 I, the changes of T 3 and T 4 level of serum were tested by radioimmunoassay. The improvement of clinical symptoms has been observed in 46 cases with teen-age hyperthyroidism by 131 I before and after treatment. Results: 39 of 46 (84%) has been proved complete responses (CR), partial responses (PR) 7 cases. 3 months later; we found that 39 patients have hypothyroidism symptoms, T 3 and T 4 level of serum decreased. There are significance increases of TSH 23 percent patients. Conclusion: It has been proved that treatment of teen-age hyperthyroidism by 131 I is effective and safe

  3. Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

    DEFF Research Database (Denmark)

    Galleberg, R B; Knigge, U; Tiensuu Janson, E

    2017-01-01

    Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce......., particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.......Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce....... The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods: 32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended...

  4. Pruritus in hemodialysis patients: Results from Fresenius dyalisis center, Banja Luka, Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Zoran Vrucinic

    2015-07-01

    Full Text Available Introduction: Uremic pruritus (UP is a common and distressing complication of end-stage renal disease (ESRD. Aglobal cross-sectional study of 18,000 hemodialysis patientsreported a 42% prevalence of moderate or extreme UP, which was strongly associated with sleep disturbance, depression, impaired quality of life, and mortality. Pruritus is commonly encountered in individuals with end-stage renal disease (ESRD on hemodialysis (HD. Materials and Methods: This cross-sectional study was performed in order to find out the prevalence of pruritus in patients on regular maintenance hemodialysis (HD as well as to analyze its relationship to age, sex of the patient, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose, parameters in the beggining of the study and six months after. The data were analyzed by descriptive statistics- Wilcoxon Signed Rank Test and Chi-square test with Yates correction factor. Results: Sixty and two patients with ESRD (age ranging from 31 to 87years free from systemic, skin or psychiatric disorders and other secondary causes attributable to pruritis, undergoing maintenance HD (duration on HD 4-348months; mean 86.97 and median 79,5months at Fresenius dialysis center, Banja Luka, Bosnia and Herzegovina were evaluated for pruritus. Pruritus has been discovered in 21 out of 34males (54,8% and 6 out of 28females (22,2%. Our study as many others showed that pruritus is very common (45.2% in HD patients. Applying c2 test with Yates correction factor is highly statistically significant (c2 = 8.003, p = 0.005 by gender. Research of the gender revealed that pruritus appeared more in men analysis. There were no significant differences between other measured markers: to age, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose in patients with pruritus and in patients without pruritus. Conclusions:This first cross-sectional study

  5. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital

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    Sevim Kavuncu

    2016-08-01

    Full Text Available Objectives: To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL in a tertiary referral eye hospital. Materials and Methods: Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. Results: The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. Conclusion: IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.

  6. LONG-TERM TREATMENT RESULTS OF BONE SARCOMA PATIENTS WITH CONSIDERATION OF SERUM METALLOPROTEINASE LEVELS

    Directory of Open Access Journals (Sweden)

    I. V. Babkina

    2015-01-01

    Full Text Available Background: Bone sarcomas are extremely malignant prone to rapid hematogenic metastasing. Evaluation of biological marker expression by the tumor is important not only for the search of new potential chemotherapy targets, but for the assessment of the disease prognosis.Aim: A comparative evaluation of matrix metalloproteinases (MMP-2, -7, -9 and tissue inhibitor of metalloproteinase-1 (TIMP-1 in the serum of patients with primary bone tumors and in healthy people to identify their potential association with the histological characteristics of the tumor and the disease prognosis.Materials and methods: A comparative study of serum MMP-2, -7, -9, and TIMP-1 levels was performed in 54 patients with primary bone tumors (malignant, 45 patients, including central osteosarcoma in 21, periosteal osteosarcoma in 4, Ewing's sarcoma in 11, primary chondrosarcoma in 6, undifferentiated pleomorphic sarcoma in 3, and borderline giant cell tumors in 9 and in 26 healthy individuals with the use of the immunoenzyme technique (Biosource, USA, for TIMP-1 and R&D, USA, for MMP-2, -7, and -9. Results: The TIMP-1 levels in the serum of patients with central and periosteal osteosarcomas were significantly higher than in the serum of healthy controls (р = 0.038 and p = 0.007, respectively. The MMP-9 levels in patients with bone malignancies were significantly lower than that in the normal controls (p < 0.05. There was a positive correlation between serum TIMP-1 and MMP-9 levels in patients with central, periosteal and Ewing's sarcomas (r = 0.37, p = 0.024. No significant differences in the 5-year survival rates related to serum TIMP-1, MMP-2, -7, -9 levels were found in patients with bone sarcomas. However, in those with osteosarcoma and serum MMP-2 > 160 ng/ml, the overall 5-year survival rate was 1.6-fold higher than in those with lower MMP-2 levels, and in those with ММP-9 levels < 377 ng/ml, the 5-year survival rate was 1.4-fold higher than in patients with

  7. Extensively coated revision stems in proximally deficient femur: Early results in 15 patients

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    Marya SKS

    2008-01-01

    Full Text Available Background: Hip replacement following failed internal fixation (dynamic hip screw for intertrochanteric fractures or previous hip arthroplasty presents a major surgical challenge. Proximal fitting revision stems do not achieve adequate fixation. Distal fixation with long-stemmed extensively coated cementless implants (like the Solution™ system affords a suitable solution. We present our early results of 15 patients treated with extensively coated cementless revision stems. Materials and Methods: Fifteen patients with severely compromised proximal femora following either failed hip arthroplasty or failed internal fixation (dynamic hip screw fixation for intertrochanteric fractures were operated by the senior author over a two-year period. Eight patients had aseptic loosening of their femoral stems following cemented hip replacements, with severe thinning of their proximal cortices and impending stress fractures. Seven had secondary hip arthritis following failure of long implants for comminuted intertrochanteric or subtrochanteric femoral fractures. All patients were treated by removal of implant (cemented stems/DHS implants and insertion of long-stemmed extensively coated cementless revision (′ Solution™; DePuy, Warsaw (IN, US′ stems along with press-fit acetabular component (Duraloc Cup, DePuy, Warsaw (IN, US. All eight hip revisions needed extended trochanteric osteotomies. Results: All patients were primarily kept in bed on physiotherapy for six weeks and then gradually progressed to weight-bearing walking over the next six to eight weeks. The Harris Hip Scores and patient satisfaction were used for final evaluation. We achieved good results in the short term studied. In our first three patients (all following failed cemented total hip replacements, we resorted to cerclage wiring to hold osteotomised segments (done to facilitate stem removal. The subsequent 12 proceeded without the need for cerclage wiring. One patient had a

  8. Patient perspectives on the impact of Crohn’s disease: results from group interviews

    Directory of Open Access Journals (Sweden)

    Norton BA

    2012-07-01

    Full Text Available Beth-Ann Norton,1 Rosemarie Thomas,2 Kathleen G Lomax,2 Sharon Dudley-Brown31Massachusetts General Hospital, Boston, MA, USA; 2Abbott Laboratories, Abbott Park, IL, USA; 3Johns Hopkins University, Schools of Medicine and Nursing, Baltimore, MD, USAAim: To understand the impact of Crohn’s disease (CD on various aspects of daily life from the perspective of patients living with CD. Awareness of the disease and biologic therapies, patient satisfaction and adherence, and physician (provider relationships were also assessed.Background: CD is a chronic, inflammatory, autoimmune disorder of the gastrointestinal tract that substantially impacts patients’ physical and emotional well-being. For patients eligible for biologic therapy, anti-tumor necrosis factor agents represent an important addition to the available therapies for CD.Methods: The study sample included biologic-naïve and biologic-experienced patients who had self-reported moderate to severe CD, were under the care of a specialist, and agreed to film a video diary and participate in a focus group. Data from the videos and group interviews were collected from May to June of 2009 and summarized qualitatively by grouping similar answers and quotations.Results: Of the 44 participants who submitted video diaries, 23 were biologic-experienced and 21 were biologic-naïve. Participants stated that CD caused fear and embarrassment, that they were reluctant to share the full impact of CD with family and providers, and that they relied on their provider for treatment decisions. Many participants accepted a new state of normalcy if their current medication helped their most bothersome symptoms without providing sustained remission. Participants receiving biologic therapy generally were more informed, more satisfied, and more likely to adhere to treatment regimens.Conclusion: Participants’ responses suggest a need for more patient education and more collaborative relationships between patients and

  9. Squamous cell carcinoma of the oropharynx--an analysis of treatment results in 289 consecutive patients

    International Nuclear Information System (INIS)

    Johansen, L.V.; Grau, C.; Overgaard, J.

    2001-01-01

    In this retrospective study the results of primary and salvage treatment of oropharyngeal carcinoma were evaluated. A total of 289 consecutive patients (103 females and 186 males) were included in the study. Most tumours originated in the tonsil area (58%) and comprised stages I 8%, II 19%, III 46% and IV 28%. The primary treatment was delivered with curative intent in 276 cases (96%). Of these, 266 received primary radiotherapy. The median radiation dose was 62 Gy, given as laterally opposed fields to the primary tumour and bilateral neck. Eight patients were treated with primary surgery and two with chemotherapy as part of a curatively intended treatment programme including radiotherapy. Six patients received palliative treatment, and seven were not treated at all. Out of 276 tumours treated with curative intent, 173 reappeared; 72% recurred in T position, 38% in N position, and 12% at distant metastatic sites, some in combination. Salvage surgery was possible in 52 patients, and 24 treatments were successful. Salvage radiotherapy or cryotherapy was used in 22 patients and 4 were controlled. For the entire group, the 5-year locoregional tumour control, disease-specific survival and overall survival rates were 38%, 44% and 31%, respectively. For patients treated with curative intent, clinical T- and N-stage, stage, tumour size, gender, age, and pretreatment haemoglobin were significant prognostic parameters in a univariate analysis. The Cox multivariate analysis showed that T-stage, N-stage and gender were independent prognostic factors. It is concluded that T-stage, N-stage and gender are significant independent prognostic factors. The primary control of the carcinoma in the T-position is crucial for overall success, but salvage surgery is found to have a favourable success rate in patients suitable for relapse treatment

  10. Clinical Profile and Prognosis of Patients with Right Ventricular Dilated Cardiomyopathy: Results of a Prospective Study

    Directory of Open Access Journals (Sweden)

    Ya.R. Akhmatov

    2015-12-01

    Full Text Available The aim of our study was to investigate the clinical prevalence of dilated cardiomyopathy (DCM with predominantly failure of the right-side heart (right ventricular DCM, RV-DCM, and features of the clinical course and prognosis of the disease compared to DCM with biventricular heart failure (BV-HF. The study design suggests a prospective observation of 300 patients with idiopathic DCM between 2000 and 2012. Herewith, we followed the criteria of the WHO/ISFC Task Force (1995 on the Definationa and Classification of Cardiomyopathies. All patients underwent a comprehensive examination. Two groups were formed for further comparative analysis. Group 1 included 22 patients (mean age 42.9±14.3 years, male/female 5/17 with RV-DCM. Group 2 included 38 patients (mean age 43.6±13.8, male/female 29/9 with DCM and BV-HF. The groups were matched for age, sex, NYHA class II-III, and disease duration. According to our aim, we studied 5-year survival prognosis and analyzed the incidence and causes of deaths, as well as the occurrence of nonfatal complications of the disease. Medical therapy for DCM patients was performed according to the CHF therapy guidelines (ACC/AHA 2001, 2005. The results of our investigations during many years of research have shown that the clinical incidence of RV-DCM was 7.3% among all forms of DCM. The study of life prognosis in patients with 2 forms of DCM showed that 5-year mortality of patients was about 50%. Herewith, we detected the differences in causes of death depending on the type of heart damage, primarily development of fatal pulmonary embolism.

  11. Squamous cell carcinoma of the oropharynx--an analysis of treatment results in 289 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, L.V.; Grau, C.; Overgaard, J. [Aarhus Univ. Hospital (Denmark). Dept. of Experimental Clinical Oncology

    2001-01-01

    In this retrospective study the results of primary and salvage treatment of oropharyngeal carcinoma were evaluated. A total of 289 consecutive patients (103 females and 186 males) were included in the study. Most tumours originated in the tonsil area (58%) and comprised stages I 8%, II 19%, III 46% and IV 28%. The primary treatment was delivered with curative intent in 276 cases (96%). Of these, 266 received primary radiotherapy. The median radiation dose was 62 Gy, given as laterally opposed fields to the primary tumour and bilateral neck. Eight patients were treated with primary surgery and two with chemotherapy as part of a curatively intended treatment programme including radiotherapy. Six patients received palliative treatment, and seven were not treated at all. Out of 276 tumours treated with curative intent, 173 reappeared; 72% recurred in T position, 38% in N position, and 12% at distant metastatic sites, some in combination. Salvage surgery was possible in 52 patients, and 24 treatments were successful. Salvage radiotherapy or cryotherapy was used in 22 patients and 4 were controlled. For the entire group, the 5-year locoregional tumour control, disease-specific survival and overall survival rates were 38%, 44% and 31%, respectively. For patients treated with curative intent, clinical T- and N-stage, stage, tumour size, gender, age, and pretreatment haemoglobin were significant prognostic parameters in a univariate analysis. The Cox multivariate analysis showed that T-stage, N-stage and gender were independent prognostic factors. It is concluded that T-stage, N-stage and gender are significant independent prognostic factors. The primary control of the carcinoma in the T-position is crucial for overall success, but salvage surgery is found to have a favourable success rate in patients suitable for relapse treatment.

  12. Gadolinium Use in Spine Pain Management Procedures for Patients with Contrast Allergies: Results in 527 Procedures

    International Nuclear Information System (INIS)

    Safriel, Yair; Ang, Roberto; Ali, Muhammed

    2008-01-01

    Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered

  13. [Early results after varicose vein surgery--a multicenter patient inquiry].

    Science.gov (United States)

    Hermanns, H-J

    2008-08-01

    Beside varicose vein surgery, endovenous procedures (endovenous laser therapy, VNUS and foam sclerotherapy) are now therapeutic options with the following advantages: low invasiveness, only out-patient operations, quick resumption of general activities. Whether or not classical vein surgery today still fulfills patient demands was analysed by a study group of German vascular surgeons (ANG) as a multicentre patient questioning. The questionnaire was subdivided into eight main complexes with 24 questions about the early results of stripping operations (from start of preparation until suture removal) and the patients answers were analysed. Answers with points (1-6) and free answers were possible. Between 1.1.2005 and 31.3.2005 18 centres for vascular surgery collected 1708 questionnaires from patients after stripping operations. The complex "preparation and information about the operation" was scored with 1.33 to 1.39. The "general organisation" of the vascular centre was scored between 1.22 and 1.30. "Pain after operation" was rated at 1.98 (immediately), 2.26 (first day) and 2.12 (third day after operation). Reasons for other problems after surgery were haematoma (3.09), problems with the compression dressing (1.67), circulatory collapse (1.51), headache (1.33), nausea (1.25). The total score for all centres was 1.47. The early results after varicose vein surgery are good up to very good. The patients' reconvalescence time is short and there is a quick resumption of general activities. The invasiveness of vein surgery seems to be overestimated. Comparative studies to evaluate the new methods are necessary. Benchmarking projects like this study are essential parts of current quality control systems.

  14. The Results of Neuroendoscopic Surgery in Patients with Posttraumatic and Posthemorrhagic Hydrocephalus.

    Science.gov (United States)

    Chrastina, Jan; Novák, Zdeněk; Zeman, Tomáš; Feitová, Věra; Hrabovský, Dušan; Říha, Ivo

    2018-05-01

    Posttraumatic hydrocephalus (PTH) and posthemorrhagic hydrocephalus (PHH) were previously considered not suitable for neuroendoscopic treatment. New hydrocephalus theories support possible successful neuroendoscopy in such patients. This study presents the results of neuroendoscopy in PTH and PHH with a background analysis. From 130 hydrocephalic patients after neuroendoscopic surgeries, 35 cases with PTH (n = 11) or PHH (n = 24; acute: n = 9, subacute: n = 10, chronic: n = 5) were found. The success rate (Glasgow Outcome Scale [GOS] score 4 or 5 without shunt) and clinical outcome (GOS score) of endoscopic third ventriculostomy (ETV) were analyzed. During the study period, 34 patients had ventriculoperitoneal shunts implanted, including 2 PTH and 5 PHH patients (all chronic). The success rate of ETV in PTH was 54.5%. In acute PHH, the success rate was 33.3%, 42.8% after excluding devastating hematomas. A post-ETV shunt was implanted in 1 patient (massive subarachnoid hemorrhage [SAH]) with final GOS score of 5. In subacute cases, the ETV success rate was 40% (no post-ETV shunts). In chronic PHH, only 1 patient with a GOS score of 5 was shunt-free (20%). The cause of ETV failure was massive SAH. Low final GOS score was caused by the extent of intracerebral bleeding or extracranial problems. The main indications for primary shunt implantation in PTH and PHH were infectious complications. The rate of good outcomes was 0% in PTH and 40% in PHH. The best results of neuroendoscopy were achieved in PTH and acute PHH. ETV failures were associated with massive SAH; arachnoid cistern blockage and scarring precludes ETV success. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Does extubation result in haemodynamic instability in patients following coronary artery bypass grafts?

    Science.gov (United States)

    Walthall, H; Ray, S; Robson, D

    2001-10-01

    Coronary heart disease and its management continue to be at the centre of Government health policy. The present political climate demands clinical effectiveness and best practice should be established, while maintaining the philosophy of cost-effectiveness and resource management. These directives have led practitioners to question the care of patients following coronary artery bypass surgery, in particular the role of mechanical ventilation and the subsequent act of extubation. A retrospective study of 89 patients who had coronary artery bypass grafts (emergency and elective) was undertaken, to establish if extubation had a significant effect on the haemodynamic status of patients with variable degrees of left ventricular function (19% with poor left ventricular function). The study found that extubation was achieved within a mean time of 4.97 hours following return from surgery. Extubation resulted in a significant increase in heart rate (P = 0.001), as well as a respiratory acidosis (pCO2: P = 0.000; pH: P = 0.000). However, the stability of the patient was not compromised, with neither mean arterial blood pressure (P = 0.825) nor oxygenation levels (P = 0.267) being significantly altered by extubation. On multivariate analysis, the act of extubation had no significant effect on any of the dependent variables. These results suggest that it is not extubation alone that has an impact on the haemodynamic stability of patients following coronary artery bypass grafts, but that this is indeed multifactorial. Therefore extubation is 'safe' practice for patients with varying degrees of left ventricular function following coronary artery bypass grafts. Limitations of the study are acknowledged.

  16. A new patient classification for laser resurfacing and peels: predicting responses, risks, and results.

    Science.gov (United States)

    Fanous, Nabil

    2002-01-01

    Traditional classifications for skin treatment modalities are based on skin characteristics, the most important being skin color. Other factors are considered as well, such as oiliness, thickness, pathology, and sensitivity. While useful, these classifications are occasionally inadequate in predicting and explaining the outcome of some peels, dermabrasions, or laser resurfacing procedures. Why, for example, would a Korean patient with a light white skin inadvertently develop more hyperpigmentation than his darker skinned French counterpart? The new classification introduced here is based on the racial and genetic origins of patients. It suggests that racial genetic predisposition is the determining factor in human response to skin injury, including skin treatments. This classification takes into account both skin and features, rather than skin alone. It offers a new approach in evaluating patients scheduled for skin peels or laser resurfacing, in the hope of helping physicians to better predict reactions, select the appropriate type and intensity of the skin treatment and, ultimately, better control the outcome. Six categories (sub-races) are described: Nordics, Europeans, Mediterraneans, Indo-Pakistanis, Africans, and Asians. The reaction of each sub-race to peels, laser resurfacing, or dermabrasion is analyzed. The risks associated with each group are noted. This new classification provides physicians with a practical way to evaluate patients prior to treatment, with a view to determining each patient's suitability, postoperative reaction, the likelihood of complications, and likely result.

  17. Tamsulosin palliates radiation-induced urethritis in patients with prostate cancer: results of a pilot study

    International Nuclear Information System (INIS)

    Prosnitz, Robert G.; Schneider, Lindsey; Manola, Judy; Rocha, Sean; Loffredo, Marian; Lopes, Lynn; D'Amico, Anthony V.

    1999-01-01

    Purpose: A pilot study was performed to determine the effectiveness of Flomax (tamsulosin HCl) in the management of acute radiation urethritis in prostate cancer patients undergoing conformal external beam radiation therapy (RT). Potential predictors of response to Flomax were evaluated. Methods and Materials: From January 1998 to April 1998, 26 consecutive patients who developed symptoms of radiation urethritis while undergoing RT for prostate cancer were treated with Flomax, a superselective α 1A -adrenergic antagonist. A genitourinary review of systems served as the instrument used to assess baseline urinary function and treatment response. Results: The initial response rate to Flomax was 62% (16/26) at the 0.4 mg level and 60% (6/10) at the 0.8 mg level. Half of the 16 patients who initially responded to 0.4 mg subsequently progressed. Three-fourths of those patients who progressed, however, achieved a durable response with the 0.8 mg dose. Therefore urinary symptoms were ultimately controlled in 77% (20/26) of the patients. After correcting for the testing of multiple hypotheses (n = 5), the presence of benign prostatic hyperplasia (BPH) approached statistical significance for predicting the initial response to the 0.4 mg dose of Flomax (78% vs. 25%, p = 0.03). Conclusion: Flomax appears to be effective in relieving the symptoms of radiation urethritis. A Phase II trial is justified and in progress

  18. Homeopathic medical practice: Long-term results of a cohort study with 3981 patients

    Directory of Open Access Journals (Sweden)

    Baur Roland

    2005-11-01

    Full Text Available Abstract Background On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. Methods In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10 and quality of life at baseline, and after 3, 12, and 24 months. Results A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 ± 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p Conclusion Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

  19. Diagnostic performance of 320-detector CT coronary angiography in patients with atrial fibrillation: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Lei; Yang, Lin; Fan, Zhanming; Yu, Wei; Lv, Biao; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China)

    2011-05-15

    To evaluate the feasibility, diagnostic accuracy, and radiation dose of CT coronary angiography (CTCA) in patients with atrial fibrillation (AF) using 320-detector CT. Thirty-seven patients with persistent AF and suspected coronary artery disease (CAD) were enrolled. All patients underwent both 320-detector CTCA and conventional coronary angiography (CCA). CT image quality and the presence of significant ({>=}50%) stenosis were evaluated by two radiologists blinded to the results of CCA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using CCA as the reference standard. Differences in detection of coronary artery stenosis between 320-detector CTCA and CCA were evaluated with McNemar's test. Patient radiation dose was calculated by multiplying dose length product by conversion coefficient of 0.017. In total 474 evaluated coronary segments, 459 (96.8%) segments were diagnostically evaluable. On per-segment analysis, sensitivity, specificity, PPV and NPV were 90.0% (18 of 20), 99.3% (436 of 439), 85.7% (18 of 21) and 99.5% (436 of 438). No significant difference was found between 320-detector CTCA and CCA on the detection of significant stenosis (P = 1.000). Effective doses of 320-detector CTCA was 13.0 {+-} 4.7 mSv. 320-detector CTCA is feasible and accurate in excluding CAD in patients with AF. (orig.)

  20. NEFOPAM IN THE STRUCTURE OF PERIOPERATIVE MULTIMODAL ANALGESIA IN PATIENTS WITH LUMBAR DISC HERNIATION: PRELIMINARY RESULTS

    Directory of Open Access Journals (Sweden)

    P. G. Genov

    2015-01-01

    Full Text Available PURPOSE OF THE STUDY. To compare efficacy and safety of nefopam and paracetamol as components of the preventive multimodal anesthesia (PMA in patients operated on for a hernia of an intervertebral disc (hID.MATERIAL AND METHODS. In 2013, 35 patients were operated on for hID. Group 1 (21 received PMA including wound infiltration by bupivacaine, ketoprofen and paracetamol. Group 2 (15 received nefopam instead of paracetamol. Intensity of postoperative pain, side effects and satisfaction of patients with anesthesia were assessed, and in 6 months later — existence and intensity of chronic pain.RESULTS. Intensity of postoperative pain, satisfaction with anesthesia, and also frequency and intensity of chronic pain didn’t differ in group 1 and 2. Occurrence of undesirable reactions was higher in group 2.CONCLUSION. In patients receiving nefopam and paracetamol as components of PMA, intensity of postoperative pain and also occurence and intensity of chronic pain don’t differ, but the patients receiving to nefopam, experience the undesirable reactions more often which do not affect satisfaction with anesthesia. 

  1. Physician-patient communication about overactive bladder: Results of an observational sociolinguistic study

    Science.gov (United States)

    Hahn, Steven R.; Bradt, Pamela; Hewett, Kathleen A.; Ng, Daniel B.

    2017-01-01

    Introduction Overactive bladder (OAB) and urinary incontinence are common problems that have significant impact on quality of life (QOL). Less than half of sufferers seek help from their physicians; many who do are dissatisfied with treatment and their physicians’ understanding of their problems. Little is known about the sociolinguistic characteristics of physician-patient communication about OAB in community practice. Methods An IRB-approved observational sociolinguistic study of dialogues between patients with OAB and treating physicians was conducted. Study design included semi-structured post-visit interviews, post-visit questionnaires, and follow-up phone calls. Conversations were analyzed using techniques from interactional sociolinguistics. Results Communication was physician- rather than patient-centered. Physicians spoke the majority of words and 83% of questions were closed-ended. The impact of OAB on QOL and concerns about and adherence to treatment were infrequently addressed by physicians, who were poorly aligned with patients in their understanding. These topics were addressed more frequently when open-ended questions successfully eliciting elaborated responses were used in ask-tell-ask or ask-tell sequences. Discussion Clinical dialogue around OAB is physician-centered; topics critical to managing OAB are infrequently and inadequately addressed. The use of patient-centered communication is correlated with more discussion of critical topics, and thus, more effective management of OAB. PMID:29140974

  2. [Restoring vision in blind patients following photoreceptor degeneration: clinical results and future challenges].

    Science.gov (United States)

    Bendali, Amel; Lorach, Henri; Djilas, Milan; Marre, Olivier; Bensoman, Ryad; Rousseau, Lionel; Lissorgues, Gaëlle; Scorsone, Emmanuel; Bergonzo, Philippe; Garrido, Jose A; Sahel, José Alain; Picaud, Serge

    2013-01-01

    Retinal prostheses aim at restoring vision in patients blind from photoreceptor degeneration by electrically stimulating the residual retinal tissue. Currently, the most efficient implants are either inserted in the subretinal space or on the vitreal side of the retina (epi-retinal). Although the residual tissue can partly degenerate, it was shown that acute stimulation of residual neurones can induce visual percepts. Recently, a clinical trial with the epiretinal Argus2 device (60 electrodes) from the company 2nd Sight enabled most patients to orient and find light targets, some even reading words. This device has received a CE mark. Surprisingly, when the subretinal implant from the company Retina Implant AG displaying many more electrodes (1500 electrodes) was evaluated in clinical trials, the patient visual performances were fairly similar. The restored visual performances of the patients demonstrate that blind patients can recover some visual function when their residual retina is properly stimulated. However, the resolution is not yet sufficient to perform complex tasks such as autonomous locomotion, face identification or text reading. Several challenges remain to generate an increase in pixel density corresponding to the increase in electrode number and density. These challenges include the stimulation modality, the tissue/implant interface design, the electrode materials, and the visual information encoder. This review will discuss these great challenges after introducing the major clinical results. © Société de Biologie, 2013.

  3. Long-term results of radiotherapy in patients with chronic palmo-plantar eczema or psoriasis

    International Nuclear Information System (INIS)

    Sumila, M.; Notter, M.; Bodis, S.; Gruber, G.; Itin, P.

    2008-01-01

    Background and Purpose: Radiotherapy (RT) is well accepted for therapy-refractory palmo-plantar eczema or psoriasis, despite of lacking evidence regarding beneficial long term effects. Furthermore, the optimal irradiation dose is unknown. We evaluated the outcome of RT with two different RT single/total dose (SD/TD) treatment policies. Patients and Methods: 28 consecutive patients with therapy-refractory eczema (n = 22) or psoriasis (n 6) of palms and/or soles were irradiated twice a week either with a D max SD of 1 Gy (6/98-5/03; median TD: 12 Gy) or 0.5 Gy (6/03-7/04; median TD: 5 Gy). Median age was 52 years (27-71), median follow-up 20 months (4-76). Totally 88 regions were treated, 49 with 1 Gy, 39 with 0.5 Gy SD. Eight different symptoms were scored from 0 (absent) -3 (severe), giving a possible sum score of 0-24. Patients' rating of RT result was also documented (worse/stable/better/complete remission). Results: The sum score was 15 (6-23) before RT, 2 (0-16) at the end of RT, and 1 (0-21) at last follow-up, respectively. The improvement was highly significant in both treatment regimens. Better or complete remission by the patients were reported in 44 and 39 (= 83 out of 88) localisations, that was often stable during the follow-up. 5 (6%) regions in 3 (11%) patients didn't benefit from RT. Conclusion: RT reveals excellent results in palmo-plantar eczema or psoriasis. We recommend a SD of 0.5 Gy twice a week up to a TD of 4-5 Gy. (orig.)

  4. Long-term results of radiotherapy in patients with chronic palmo-plantar eczema or psoriasis

    Energy Technology Data Exchange (ETDEWEB)

    Sumila, M.; Notter, M.; Bodis, S.; Gruber, G. [State Hospital, Aarau (Switzerland). Inst. of Radiation Oncology; Itin, P. [State Hospital, Aarau (Switzerland). Dept. of Dermatology

    2008-04-15

    Background and Purpose: Radiotherapy (RT) is well accepted for therapy-refractory palmo-plantar eczema or psoriasis, despite of lacking evidence regarding beneficial long term effects. Furthermore, the optimal irradiation dose is unknown. We evaluated the outcome of RT with two different RT single/total dose (SD/TD) treatment policies. Patients and Methods: 28 consecutive patients with therapy-refractory eczema (n = 22) or psoriasis (n = 6) of palms and/or soles were irradiated twice a week either with a D{sub max} SD of 1 Gy (6/98-5/03; median TD: 12 Gy) or 0.5 Gy (6/03-7/04; median TD: 5 Gy). Median age was 52 years (27-71), median follow-up 20 months (4-76). Totally 88 regions were treated, 49 with 1 Gy, 39 with 0.5 Gy SD. Eight different symptoms were scored from 0 (absent) -3 (severe), giving a possible sum score of 0-24. Patients' rating of RT result was also documented (worse/stable/better/complete remission). Results: The sum score was 15 (6-23) before RT, 2 (0-16) at the end of RT, and 1 (0-21) at last follow-up, respectively. The improvement was highly significant in both treatment regimens. Better or complete remission by the patients were reported in 44 and 39 (= 83 out of 88) localisations, that was often stable during the follow-up. 5 (6%) regions in 3 (11%) patients didn't benefit from RT. Conclusion: RT reveals excellent results in palmo-plantar eczema or psoriasis. We recommend a SD of 0.5 Gy twice a week up to a TD of 4-5 Gy. (orig.)

  5. Medium dose rate brachytherapy for patients with cervical carcinoma; early result of a prospective study

    Directory of Open Access Journals (Sweden)

    Amouzegar Hashemi F

    2009-03-01

    Full Text Available "nBackground: Treatment of cervical carcinoma is routinely performed with Low Dose Rate (LDR brachytherapy, but Brachytherapy in our department is done with Medium Dose Rate (MDR due to the technical characteristics of the machine available here. Thus we decided to evaluate the results of this treatment in our department in a prospective study. "nMethods: Between March 2006 and July 2008, 140 patients with histologic diagnosis of cervical carcinoma referred to Tehran Cancer Institute; were treated with external beam radiotherapy (44-64 Gy to whole pelvis and MDR brachytherapy (8-30 Gy to Point A with a dose rate of 2.2±0.3 Gy/h. "nResults: 121 patients were followed up for a median time of 18 months (range: 9-39 m. There were 11%(6/54 local recurrence for surgery and adjuvant radiotherapy group; 25%(16/65 for radical radiotherapy group, and 19%(23/121 for all patients. Rectal and bladder complications incidence for all patients were 10%(12/121 and 13%(16/121 respectively. High grade complication was shown only in one patient in radical radiotherapy group. In this study 3-years disease free survival and overall survival were 73% and 92% respectively, and disease stage (p=0.007 and overall treatment time (p=0.05 were the significant factors affecting disease free survival. "nConclusions: Results of this series suggest that the use of external beam radiotherapy and MDR brachytherapy with about 20% dose reduction in comparison with LDR can be an acceptable technique with regard to local control and complications.

  6. Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?

    Science.gov (United States)

    Ireland, Graham; Brown, Simon G A; Buckley, Nicholas A; Stormer, Jeff; Currie, Bart J; White, Julian; Spain, David; Isbister, Geoffrey K

    2010-09-06

    To determine which laboratory tests are first associated with severe envenoming after a snakebite, when (ie, how long after the bite) the test results become abnormal, and whether this can determine a safe observation period after suspected snakebite. Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite. Severe envenoming was defined as venom-induced consumption coagulopathy (VICC), myotoxicity, neurotoxicity or thrombotic microangiopathy. International normalised ratio (INR), activated partial thromboplastin time (aPTT), creatine kinase (CK) level, and neurological examination. There were 240 patients with severe envenoming, 75 with minor envenoming and 163 non-envenomed patients. Of 206 patients with VICC, 178 had an INR > 1.2 (abnormal) on admission, and the remaining 28 had an INR > 1.2 within 12 hours of the bite. Of 33 patients with myotoxicity, a combination of CK > 250 U/L and an abnormal aPTT identified all but two cases by 12 hours; one of these two was identified within 12 hours by leukocytosis. Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min - 12 h). The combination of serial INR, aPTT and CK tests and repeated neurological examination identified 213 of 222 severe envenoming cases (96%) by 6 hours and 238 of 240 (99%) by 12 hours. Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.

  7. Median of patient results as a tool for assessment of analytical stability.

    Science.gov (United States)

    Jørgensen, Lars Mønster; Hansen, Steen Ingemann; Petersen, Per Hyltoft; Sölétormos, György

    2015-06-15

    In spite of the well-established external quality assessment and proficiency testing surveys of analytical quality performance in laboratory medicine, a simple tool to monitor the long-term analytical stability as a supplement to the internal control procedures is often needed. Patient data from daily internal control schemes was used for monthly appraisal of the analytical stability. This was accomplished by using the monthly medians of patient results to disclose deviations from analytical stability, and by comparing divergences with the quality specifications for allowable analytical bias based on biological variation. Seventy five percent of the twenty analytes achieved on two COBASs INTEGRA 800 instruments performed in accordance with the optimum and with the desirable specifications for bias. Patient results applied in analytical quality performance control procedures are the most reliable sources of material as they represent the genuine substance of the measurements and therefore circumvent the problems associated with non-commutable materials in external assessment. Patient medians in the monthly monitoring of analytical stability in laboratory medicine are an inexpensive, simple and reliable tool to monitor the steadiness of the analytical practice. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Adherence to medicamentous therapy of type 2 diabetes mellitus: results of patient questionnaires

    Directory of Open Access Journals (Sweden)

    Elena Viktorovna Surkova

    2009-03-01

    Full Text Available Aim. To assess the frequency and character of non-compliance with medicamentous therapy of type 2 diabetes mellitus based on the results of a questionnaire study. Materials and methods. A special qiuestionnaire form was filled by 745 patients (232 men of mean age 60.3?10.4 years, duration of the disease 6.4?5.5 years and mean HbA1c level 7.7?1.1%. Results. 52.8% of the patients reported non-compliance with medication. The most frequent profile of non-compliance was the change of time and occasional omission of therapeuticdoses (42.7 and 42.2% respectively, the main cause being mere forgetfulness (71.2%. Other factors (30.8% included poor understanding of medication schedule andfears of health hazard from the following of medical advice. Patients to whom monotherapy with glibomet was prescribed (n=277 showed a lower non-compliance rate and lowerHbA1c level despite the intake of fewer daily doses than patients taking other oral hypoglycemic agents (7.0?1.0 vs 7.3?1.3%, p

  9. Percutaneous insertion of inferior vean cava filter:clinical results of 8 patients

    International Nuclear Information System (INIS)

    Bae, Kyung Soo; Shin, Hyun Woong; Park, No Hyuck; Ryeom, Hun Kyu; Kim, Yong Joo

    1997-01-01

    To evaluate the efficacy and clinical results of percutaneous insertion of inferior vena cava(IVC) filter. Over a two year period, eight IVC filters were placed in eight patients with pulmonary thromboembolism resulting from deep vein thrombosis of the legs. The indications for placement were contraindication to anticoagulation(3), and recurrent pulmonary embolism during anticoagulant therapy(5). Both femoral(7) and jugular(1) routes were used for percutaneous transvenous insertion. To delineate the caval anatomy and to ensure placement just caudal to the renal vein, a cavogram was obtained before filter placement. Bird's Nest (7) and Greenfield (1) filters were inserted. Follow-up information was obtained by means of duplex sonography, CT scan, abdominal radiograph, and perfusion scan of the lungs, followed by clinical evaluation. In all cases, procedures were technically successful. Placement complications occurred in three patients. In one, the filter was inadvertently placed above the iliac bifurcation; in the other two, prolapse of the Bird's Nest filter wire occurred. Occlusion of IVC occurred in two patients, and recurrent pulmonary embolism was suspected in one, who suffered from chest pain and short-ness of breath. In the other patients, there was no clinical evidence of recurrence of the pulmonary embolism. Insertion of an inferior vena cava filter is a safe and effective method for the prevention of pulmonary embolism when anticoagulant therapy is either ineffective or contraindicated

  10. Echocardiography and cardiac MRI in mutation-negative hypertrophic cardiomyopathy in an older patient: a case defining the need for ICD.

    Science.gov (United States)

    Rodriguez, Fatima; Degnan, Kathleen O; Seidman, Christine E; Mangion, Judy R

    2014-08-01

    We report the case of a 67-year-old man with hypertrophic cardiomyopathy who presented for a second opinion about implantable cardio-defibrillator (ICD) placement after a witnessed syncopal episode. Despite his older age, being mutation-negative, and having a maximal septal thickness of 2.2 cm on echocardiography, he demonstrated rapid progression of myocardial fibrosis on cardiac MRI, correlating to ventricular tachyarrhythmias and syncope. We review the role of echocardiography and cardiac MRI in optimizing medical care for such patients who may not otherwise meet criteria for an ICD placement or further interventions. © 2014, Wiley Periodicals, Inc.

  11. Patient safety education at Japanese medical schools: results of a nationwide survey

    Directory of Open Access Journals (Sweden)

    Maeda Shoichi

    2012-05-01

    Full Text Available Abstract Background Patient safety education, including error prevention strategies and management of adverse events, has become a topic of worldwide concern. The importance of the patient safety is also recognized in Japan following two serious medical accidents in 1999. Furthermore, educational curriculum guideline revisions in 2008 by relevant the Ministry of Education includes patient safety as part of the core medical curriculum. However, little is known about the patient safety education in Japanese medical schools partly because a comprehensive study has not yet been conducted in this field. Therefore, we have conducted a nationwide survey in order to clarify the current status of patient safety education at medical schools in Japan. Results Response rate was 60.0% (n = 48/80. Ninety-eight-percent of respondents (n = 47/48 reported integration of patient safety education into their curricula. Thirty-nine percent reported devoting less than five hours to the topic. All schools that teach patient safety reported use of lecture based teaching methods while few used alternative methods, such as role-playing or in-hospital training. Topics related to medical error theory and legal ramifications of error are widely taught while practical topics related to error analysis such as root cause analysis are less often covered. Conclusions Based on responses to our survey, most Japanese medical schools have incorporated the topic of patient safety into their curricula. However, the number of hours devoted to the patient safety education is far from the sufficient level with forty percent of medical schools that devote five hours or less to it. In addition, most medical schools employ only the lecture based learning, lacking diversity in teaching methods. Although most medical schools cover basic error theory, error analysis is taught at fewer schools. We still need to make improvements to our medical safety curricula. We believe that this