Life expectancy in patients with rheumatoid arthritis(RA)is reduced compared to the general population owing to an increase in cardiovascular diseases(CVD)not fully explained by traditional cardiovascular risk factors...Life expectancy in patients with rheumatoid arthritis(RA)is reduced compared to the general population owing to an increase in cardiovascular diseases(CVD)not fully explained by traditional cardiovascular risk factors.In recent years,interest has been focused on the alterations in lipid metabolism in relation to chronic inflammation as one of the possible mechanisms involvedin the pathogenesis of atherosclerosis of RA patients.Research regarding this issue has revealed quantitative alterations in lipoproteins during the acute-phase reaction,and has also demonstrated structural alterations in these lipoproteins which affect their functional abilities.Although many alterations in lipid metabolism have been described in this regard,these structural changes associated with inflammation are particularly important in high-density lipoproteins as they affect their cardioprotective functions.In this respect,excessive oxidation in low-density lipoprotein(LDL)and increased lipoprotein(a)with a predominance of smaller apolipoprotein(a)isoforms has also been reported.This article will discuss proinflammatory high-density lipoproteins(pi HDL),oxidized LDL and lipoprotein(a).Elevated concentrations of these lipoproteins with marked pro-atherogenic properties have been observed in RA patients,which could help to explain the increased cardiovascular risk of these patients.展开更多
The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortali...The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.展开更多
Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been demonstrated.Our aim was to assess the impact of EBCR in³70-years-old vs.y...Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been demonstrated.Our aim was to assess the impact of EBCR in³70-years-old vs.younger post-AMI patients.Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 weeks.We evaluated changes in several outcomes based on pre-and post-CRP assessments.Results Of a total of 1607 patients,333(21%)were³70-years-old.After the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in NT-pro-BNP.In the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on age.Conclusion As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.展开更多
AIM： To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm （AAA） repair surgery, METHODS： Nine patients （aged 35-78 years; body mass index （BMI...AIM： To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm （AAA） repair surgery, METHODS： Nine patients （aged 35-78 years; body mass index （BMI） range： 23-36 kg/m2） post-surgery for AAA repair, and seven healthy control subjects （20-50 years; BMI range： 21-29 kg/m^2） were studied, Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding （Nutrison）. Recordings were analyzed for the frequency, odgin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the ^13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200μL ^13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for ^13CO2 concentration. RESULTS： The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions （P〈 0.005）. In patients there was a higher proportion of abnormally propagated bursts （71% abnormal）, which began to normalize by d 3 （25% abnormal） post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects （AUC ^13CO2 1323±244 vs 2646±365; P〈0.05, respectively）, and was reduced to the one-fitch that of healthy controls by d 3 （AUC ^13CO2 470±832 vs 2646±365; P〈 0.05, respectively）. CONCLUSION： Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intraluminal processing is necessary for efficient digestion.展开更多
Few studies have analyzed the effect of ve- nous thromboembolism （VTE） events on the prognosis of pancreatic cancer, but their results were conflicting. The pres- ent study was undertaken to determine the effect of ...Few studies have analyzed the effect of ve- nous thromboembolism （VTE） events on the prognosis of pancreatic cancer, but their results were conflicting. The pres- ent study was undertaken to determine the effect of VTE on pancreatic adenocarcinoma （PA） outcomes. METHODS： All consecutive patients diagnosed with PA from May 2004 to January 2012 in a single oncology center were retrospectively studied. Clinical, radiological and histologi- cal data at time of diagnosis or within the first 3 months after surgery, including the presence （＋） or absence （-） of VTE were collected. VTE was defined as radiological evidence of either pulmonary embolism （PE）, deep venous thrombosis without infection or catheter-related thrombosis. PA with and without PE was compared for survival using the Kaplan-Meier method to estimate overall survival. RESULTS： Among 162 PA patients with a median follow-up of 15 （3-92） months after diagnosis, 28 demonstratedVTE （＋）. PA patients with and without PE were similar for age, American Society of Anesthesiologist score, body mass index, and histo- ry of treatment. The distribution of cancer stages was similarbetween the two groups VTE （＋） and VTE （-）. The median du- ration of survival was significantly worse in the VTE （＋） group vs VTE （-） （12 vs 18 months, P=0.010）. In multivariate analysis, the presence of VTE and surgical treatment were independent prognostic factors for overall survival. CONCLUSION： VTE （＋） at time of diagnosis or within the first 3 months after surgery during treatment is an indepen- dent factor of poor prognosis in PA.展开更多
Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated ...Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated the medical records of 188 consecutive patients(mean age 68.2±9.6 years,100 males)undergone angiography and woven mesh stent implantation in femoral or popliteal arteries or both arterial segments,in our institution between January 12014 and January 12018.Target lesion revascularization and major adverse limb events at 12-month were evaluated comparing patients with 1-,2-or 3-run-off vessels in the foot.Results Interventional success was achieved in 100%.Stent implantation involved in the femoral site in 56 patients(30.3%),the femoropopliteal in 92 patients(48.9%)and the popliteal site in 40 patients(21.3%).A significant improvement of ankle-brachial index(0.29±0.6 vs.0.88±0.3,P<0.001)and Rutherford class(5.3±0.8 vs.0.7±1.9,P<0.01)were observed before discharge.The median follow-up duration was 12.3 months(inter quartile range:11.0 to 13.9).During the follow-up period,52 patients(27.6%)had clinical events.Primary patency at 12 months was 72.4%.The primary patency significantly increased when the runoff status.Comparing the number of events among patients with different number of run-off vessels,a significant difference(P<0.001)was observed for patients having one(24.0%)and two run-off vessels(15.0%).Conclusions The outcomes of Supera stent in femoropopliteal occlusive disease depend strictly on the number of run-off vessels.展开更多
AIM To analyse the risk of pregnancy(a prothrombotic state)in patients with Budd-Chiari Syndrome(BCS).METHODS Retrospective study of pregnancy in women with known BCS at single center from January 2001 to December 201...AIM To analyse the risk of pregnancy(a prothrombotic state)in patients with Budd-Chiari Syndrome(BCS).METHODS Retrospective study of pregnancy in women with known BCS at single center from January 2001 to December 2015.RESULTS Out of 53 females with BCS,7 women had 16 pregnancies.Median age at diagnosis of BCS in these women was 25 years(range 21-34 years).At least one causal factor for BCS was identified in 6 women(86%).Six women had undergone radiological decompressive treatment.All patients had anticoagulation.Six fetuses were lost before 20 wk gestation in 2 women.There were 9 deliveries over 32 wk gestation and one delivery at 27 wk.All infants did well.Seven babies were born by emergency caesarean section.There were no cases of thrombosis.Two patients had notable vaginal(PV)bleeding in 3 pregnancies.None of the patients had variceal haemorrhage.Two patients were diagnosed with pulmonary hypertension,one during pregnancyand the other in the post-partum period.There was no maternal mortality.CONCLUSION Maternal outcomes in patients with treated BCS are favourable and fetal outcomes beyond 20 wk gestation are good.There has been increased rate of caesarean section.Pulmonary hypertension is an important finding that needs further validation.These patients should be managed in centers experienced in treating high-risk pregnancies.展开更多
Objective: The aim of the study is to evaluate the effect of low-level laser therapy in comparison to compression bandage therapy in the treatment of venous ulcers. Subjects & Methods: This study was carried out i...Objective: The aim of the study is to evaluate the effect of low-level laser therapy in comparison to compression bandage therapy in the treatment of venous ulcers. Subjects & Methods: This study was carried out in the period from March 2013 to March 2014. The study included 40 adult patients with a diagnosis of venous ulcer classified as C6 according to the clinical classification of CEAP classification. The patients were divided into 2 groups: the first one included 20 patients treated by low-level laser therapy at the Rheumatology and Rehabilitation department, and the second group included 20 patients in whom we use four layers compression bandaging at the vascular surgery department. Results: 32 ulcers were treated in group I and 35 ulcers were treated in group II. The patients of group I were 7 (35%) females and 13 (65%) males, their age range were (24 - 56) years. The patients of group II were 11 (55%) males and 9 (45%) females;their age ranges were (32 - 50) years. Measurements of the ulcers size by (cm2) were taken at the beginning of therapy, at 1 month, at 2 months and at 3 months later on. The calculation of the area of the ulcer was done by using the graph papers to document the ulcer’s perpendicular linear dimensions. According to the size of the ulcer, some ulcers heal within 1 month (15.6%) ulcers in group I, and (28.5%) in group II. Some ulcers heal within 2 months (28%) in group I, and (37%) in group II. The remaining ulcers heal within 3 months or more which are (56%) ulcers in group I, and (34.2%) ulcers in group II. The recurrence rate of chronic venous leg ulcer in compression bandage technique used in group II was the least one as the total number of recurrent cases were 5 (25%), followed by laser therapy used in group I. Conclusion: There was no significant efficacy of the low-level laser therapy over the four layers compression technique in the management of chronic venous ulcers.展开更多
The Edematofibrosclerotic Panniculitis (EFP) and the Localised Adiposity (LA) have controversial pathogenesis and therapy. A single-centre observational study has been performed to assess the potential efficacy, the l...The Edematofibrosclerotic Panniculitis (EFP) and the Localised Adiposity (LA) have controversial pathogenesis and therapy. A single-centre observational study has been performed to assess the potential efficacy, the limitations and the side effects of the medical treatment of EFP and AL by means of a multicomponent nutraceutical product. Fifty female subjects have been enrolled, mean age and BMI of the patients were 46 years and 24.18 respectively. The subjects have been submitted to a two-month treatment with two tablets of a nutraceutical based on extracts of Birch (100 mg), Orthosiphon (100 mg), Red Vine Leukocyanidines (100 mg), Melilotus (5 mg) and Bromelin (150 mg). The patients have been investigated before the treatment and during the treatment (at 30 and 60 days) by means of: a) volumetry of the lower limbs with tape measurement;b) visual analogue scale assessment (VAS) of symptoms such as pain paresthesia/dysesthesia, heaviness, and of the daily diuresis;c) duplex ultrasound evaluation of the thickness of the adipose tissue at the peri-trochanteric level;d) multifrequency segmental bioimpedance (MSB) analysis for the tissue liquid component. Forty-five of the 50 enrolled subjects have completed the study and five patients have discontinued the treatment, four of which due to unexpected personal problems or health problems not related to the treatment itself and one for reporting gastrointestinal disorders (such as constipation/diarrhea) with the nutraceutical intake. At the end of the therapeutical cycle, volumetry of the limbs decreased of 7% (right) and of 6% (left). Pre/post treatment VAS assessment of symptoms showed the following mean figures: heaviness from 5.10 to 0.88;paresthesia/dysesthesia from 0.90 to 0.00;pain from 2.03 to 0.12. Diuresis increased of 31%. Duplex-ultrasound assessment of the subcutaneous adipose layers at the trochanteric level showed a reduction of slightly more than 20% at the end of the treatment in both limbs. L-Dex bioimpedance values have been as follows: 3.97 at the enrolment;1.17 at the end of the treatment (reduction of the subcutaneous tissue fluid content). The present single-centre observational study proved that the tested nutraceutical multicomponent is effective and free of relevant side effects in the treatment of EFP and AL of the lower limbs. Larger cohort studies may possibly confirm the results of this preliminary experience.展开更多
We performed a retrospective study on diabetic ketosis decompensations in 101 diabetic patients in Endocrinology and Metabolic Diseases Service of the National Hospital and Universitary Koutoukou Hubert Maga (CNHU-HKM...We performed a retrospective study on diabetic ketosis decompensations in 101 diabetic patients in Endocrinology and Metabolic Diseases Service of the National Hospital and Universitary Koutoukou Hubert Maga (CNHU-HKM) for a period of 3 years. Objective: The main objective of the study was to identify the underlying factors of ketosis decompensations for a more focused education program. Results: The mean age was 43.84 years. In half of cases (49.5%), the ketosis decompensations were inaugural for the diabetes. Type 2 diabetes was predominant with a frequency of 85.1% versus 14.9% for type 1 diabetes. The overall prevalence rate of ketosis decompensations was 21.82%. The precipitating factors were infections (51.49%) and treatment withdrawal (25.74%). The average blood glucose was 4.46 g/L with ranges of 1.86 g/L and 13 g/L. The outcome was favorable in 89.1% of cases. The mortality rate was 7.9%. The average hospital stay was 13.23 days. Conclusion: This study showed that ketosis decompensations are still frequent. The main precipitating factors are infection and therapeutic noncompliance. Preventive actions are needed through screening programs, regular monitoring and targeted education.展开更多
To determine whether mass screening of Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. Design: Single centre randomised controlled trial. Setting: All five hospitals in Viborg County, Denm...To determine whether mass screening of Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. Design: Single centre randomised controlled trial. Setting: All five hospitals in Viborg County, Denmark. Participants: All 12 639 men born during 1921- 33 and living in Viborg County. In 1994 we included men born 1921- 9(64- 73 years). We also included men who became 65 during 1995- 8. Interventions: Men were randomised to the intervention group(screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans. Outcome measures: Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms. Results: 4860 of 6333 men were screened(attendance rate 76.6% ). 191(4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 34% to 91% ) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84% ). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8% . The benefits of screening may increase with time. Conclusion: Mass screening of men aged 65 or more for abdominal aortic aneurysms reduces mortality.展开更多
Dear Editor,Inguinal lymphadenectomy represents a crucial step in both staging and treatment of penile cancer and can be curative in some patients.Nevertheless,severe morbidity can be high in up to 50%of cases.The mos...Dear Editor,Inguinal lymphadenectomy represents a crucial step in both staging and treatment of penile cancer and can be curative in some patients.Nevertheless,severe morbidity can be high in up to 50%of cases.The most-reported complications are skin necrosis,wound infection,lymphoedema,and lymphocele[1].In this setting,artery blowout syndrome(ABS)is a complication rarely described,presenting with vessels exposure through wound dehiscence,leading to arterial wall rupture with potentially life-threatening bleeding(Type III ABS).Reports have been described following radiation treatment of the groins or the neck[2,3].We present the first case of femoral artery wall rupture with severe hemorrhage after iliac and inguinal lymphadenectomy for penile cancer in a patient without previous radiation treatment.Written consent for case publication was obtained.展开更多
文摘Life expectancy in patients with rheumatoid arthritis(RA)is reduced compared to the general population owing to an increase in cardiovascular diseases(CVD)not fully explained by traditional cardiovascular risk factors.In recent years,interest has been focused on the alterations in lipid metabolism in relation to chronic inflammation as one of the possible mechanisms involvedin the pathogenesis of atherosclerosis of RA patients.Research regarding this issue has revealed quantitative alterations in lipoproteins during the acute-phase reaction,and has also demonstrated structural alterations in these lipoproteins which affect their functional abilities.Although many alterations in lipid metabolism have been described in this regard,these structural changes associated with inflammation are particularly important in high-density lipoproteins as they affect their cardioprotective functions.In this respect,excessive oxidation in low-density lipoprotein(LDL)and increased lipoprotein(a)with a predominance of smaller apolipoprotein(a)isoforms has also been reported.This article will discuss proinflammatory high-density lipoproteins(pi HDL),oxidized LDL and lipoprotein(a).Elevated concentrations of these lipoproteins with marked pro-atherogenic properties have been observed in RA patients,which could help to explain the increased cardiovascular risk of these patients.
文摘The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.
文摘Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been demonstrated.Our aim was to assess the impact of EBCR in³70-years-old vs.younger post-AMI patients.Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 weeks.We evaluated changes in several outcomes based on pre-and post-CRP assessments.Results Of a total of 1607 patients,333(21%)were³70-years-old.After the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in NT-pro-BNP.In the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on age.Conclusion As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.
基金Supported by National Health and Medical Research Council of AustraliaMargarete and Walther Lichenstein-Stiftung(Basel,Switzerland)
文摘AIM： To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm （AAA） repair surgery, METHODS： Nine patients （aged 35-78 years; body mass index （BMI） range： 23-36 kg/m2） post-surgery for AAA repair, and seven healthy control subjects （20-50 years; BMI range： 21-29 kg/m^2） were studied, Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding （Nutrison）. Recordings were analyzed for the frequency, odgin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the ^13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200μL ^13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for ^13CO2 concentration. RESULTS： The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions （P〈 0.005）. In patients there was a higher proportion of abnormally propagated bursts （71% abnormal）, which began to normalize by d 3 （25% abnormal） post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects （AUC ^13CO2 1323±244 vs 2646±365; P〈0.05, respectively）, and was reduced to the one-fitch that of healthy controls by d 3 （AUC ^13CO2 470±832 vs 2646±365; P〈 0.05, respectively）. CONCLUSION： Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intraluminal processing is necessary for efficient digestion.
基金supported by institutional funding from INSERM(Paris,France)the Aix-Marseille University(Marseille,France)by a grant INCAa-DGSO-INSERM 6038 from sites de recherche intégrésur le cancer(SIRIC)
文摘Few studies have analyzed the effect of ve- nous thromboembolism （VTE） events on the prognosis of pancreatic cancer, but their results were conflicting. The pres- ent study was undertaken to determine the effect of VTE on pancreatic adenocarcinoma （PA） outcomes. METHODS： All consecutive patients diagnosed with PA from May 2004 to January 2012 in a single oncology center were retrospectively studied. Clinical, radiological and histologi- cal data at time of diagnosis or within the first 3 months after surgery, including the presence （＋） or absence （-） of VTE were collected. VTE was defined as radiological evidence of either pulmonary embolism （PE）, deep venous thrombosis without infection or catheter-related thrombosis. PA with and without PE was compared for survival using the Kaplan-Meier method to estimate overall survival. RESULTS： Among 162 PA patients with a median follow-up of 15 （3-92） months after diagnosis, 28 demonstratedVTE （＋）. PA patients with and without PE were similar for age, American Society of Anesthesiologist score, body mass index, and histo- ry of treatment. The distribution of cancer stages was similarbetween the two groups VTE （＋） and VTE （-）. The median du- ration of survival was significantly worse in the VTE （＋） group vs VTE （-） （12 vs 18 months, P=0.010）. In multivariate analysis, the presence of VTE and surgical treatment were independent prognostic factors for overall survival. CONCLUSION： VTE （＋） at time of diagnosis or within the first 3 months after surgery during treatment is an indepen- dent factor of poor prognosis in PA.
文摘Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated the medical records of 188 consecutive patients(mean age 68.2±9.6 years,100 males)undergone angiography and woven mesh stent implantation in femoral or popliteal arteries or both arterial segments,in our institution between January 12014 and January 12018.Target lesion revascularization and major adverse limb events at 12-month were evaluated comparing patients with 1-,2-or 3-run-off vessels in the foot.Results Interventional success was achieved in 100%.Stent implantation involved in the femoral site in 56 patients(30.3%),the femoropopliteal in 92 patients(48.9%)and the popliteal site in 40 patients(21.3%).A significant improvement of ankle-brachial index(0.29±0.6 vs.0.88±0.3,P<0.001)and Rutherford class(5.3±0.8 vs.0.7±1.9,P<0.01)were observed before discharge.The median follow-up duration was 12.3 months(inter quartile range:11.0 to 13.9).During the follow-up period,52 patients(27.6%)had clinical events.Primary patency at 12 months was 72.4%.The primary patency significantly increased when the runoff status.Comparing the number of events among patients with different number of run-off vessels,a significant difference(P<0.001)was observed for patients having one(24.0%)and two run-off vessels(15.0%).Conclusions The outcomes of Supera stent in femoropopliteal occlusive disease depend strictly on the number of run-off vessels.
文摘AIM To analyse the risk of pregnancy(a prothrombotic state)in patients with Budd-Chiari Syndrome(BCS).METHODS Retrospective study of pregnancy in women with known BCS at single center from January 2001 to December 2015.RESULTS Out of 53 females with BCS,7 women had 16 pregnancies.Median age at diagnosis of BCS in these women was 25 years(range 21-34 years).At least one causal factor for BCS was identified in 6 women(86%).Six women had undergone radiological decompressive treatment.All patients had anticoagulation.Six fetuses were lost before 20 wk gestation in 2 women.There were 9 deliveries over 32 wk gestation and one delivery at 27 wk.All infants did well.Seven babies were born by emergency caesarean section.There were no cases of thrombosis.Two patients had notable vaginal(PV)bleeding in 3 pregnancies.None of the patients had variceal haemorrhage.Two patients were diagnosed with pulmonary hypertension,one during pregnancyand the other in the post-partum period.There was no maternal mortality.CONCLUSION Maternal outcomes in patients with treated BCS are favourable and fetal outcomes beyond 20 wk gestation are good.There has been increased rate of caesarean section.Pulmonary hypertension is an important finding that needs further validation.These patients should be managed in centers experienced in treating high-risk pregnancies.
文摘Objective: The aim of the study is to evaluate the effect of low-level laser therapy in comparison to compression bandage therapy in the treatment of venous ulcers. Subjects & Methods: This study was carried out in the period from March 2013 to March 2014. The study included 40 adult patients with a diagnosis of venous ulcer classified as C6 according to the clinical classification of CEAP classification. The patients were divided into 2 groups: the first one included 20 patients treated by low-level laser therapy at the Rheumatology and Rehabilitation department, and the second group included 20 patients in whom we use four layers compression bandaging at the vascular surgery department. Results: 32 ulcers were treated in group I and 35 ulcers were treated in group II. The patients of group I were 7 (35%) females and 13 (65%) males, their age range were (24 - 56) years. The patients of group II were 11 (55%) males and 9 (45%) females;their age ranges were (32 - 50) years. Measurements of the ulcers size by (cm2) were taken at the beginning of therapy, at 1 month, at 2 months and at 3 months later on. The calculation of the area of the ulcer was done by using the graph papers to document the ulcer’s perpendicular linear dimensions. According to the size of the ulcer, some ulcers heal within 1 month (15.6%) ulcers in group I, and (28.5%) in group II. Some ulcers heal within 2 months (28%) in group I, and (37%) in group II. The remaining ulcers heal within 3 months or more which are (56%) ulcers in group I, and (34.2%) ulcers in group II. The recurrence rate of chronic venous leg ulcer in compression bandage technique used in group II was the least one as the total number of recurrent cases were 5 (25%), followed by laser therapy used in group I. Conclusion: There was no significant efficacy of the low-level laser therapy over the four layers compression technique in the management of chronic venous ulcers.
文摘The Edematofibrosclerotic Panniculitis (EFP) and the Localised Adiposity (LA) have controversial pathogenesis and therapy. A single-centre observational study has been performed to assess the potential efficacy, the limitations and the side effects of the medical treatment of EFP and AL by means of a multicomponent nutraceutical product. Fifty female subjects have been enrolled, mean age and BMI of the patients were 46 years and 24.18 respectively. The subjects have been submitted to a two-month treatment with two tablets of a nutraceutical based on extracts of Birch (100 mg), Orthosiphon (100 mg), Red Vine Leukocyanidines (100 mg), Melilotus (5 mg) and Bromelin (150 mg). The patients have been investigated before the treatment and during the treatment (at 30 and 60 days) by means of: a) volumetry of the lower limbs with tape measurement;b) visual analogue scale assessment (VAS) of symptoms such as pain paresthesia/dysesthesia, heaviness, and of the daily diuresis;c) duplex ultrasound evaluation of the thickness of the adipose tissue at the peri-trochanteric level;d) multifrequency segmental bioimpedance (MSB) analysis for the tissue liquid component. Forty-five of the 50 enrolled subjects have completed the study and five patients have discontinued the treatment, four of which due to unexpected personal problems or health problems not related to the treatment itself and one for reporting gastrointestinal disorders (such as constipation/diarrhea) with the nutraceutical intake. At the end of the therapeutical cycle, volumetry of the limbs decreased of 7% (right) and of 6% (left). Pre/post treatment VAS assessment of symptoms showed the following mean figures: heaviness from 5.10 to 0.88;paresthesia/dysesthesia from 0.90 to 0.00;pain from 2.03 to 0.12. Diuresis increased of 31%. Duplex-ultrasound assessment of the subcutaneous adipose layers at the trochanteric level showed a reduction of slightly more than 20% at the end of the treatment in both limbs. L-Dex bioimpedance values have been as follows: 3.97 at the enrolment;1.17 at the end of the treatment (reduction of the subcutaneous tissue fluid content). The present single-centre observational study proved that the tested nutraceutical multicomponent is effective and free of relevant side effects in the treatment of EFP and AL of the lower limbs. Larger cohort studies may possibly confirm the results of this preliminary experience.
文摘We performed a retrospective study on diabetic ketosis decompensations in 101 diabetic patients in Endocrinology and Metabolic Diseases Service of the National Hospital and Universitary Koutoukou Hubert Maga (CNHU-HKM) for a period of 3 years. Objective: The main objective of the study was to identify the underlying factors of ketosis decompensations for a more focused education program. Results: The mean age was 43.84 years. In half of cases (49.5%), the ketosis decompensations were inaugural for the diabetes. Type 2 diabetes was predominant with a frequency of 85.1% versus 14.9% for type 1 diabetes. The overall prevalence rate of ketosis decompensations was 21.82%. The precipitating factors were infections (51.49%) and treatment withdrawal (25.74%). The average blood glucose was 4.46 g/L with ranges of 1.86 g/L and 13 g/L. The outcome was favorable in 89.1% of cases. The mortality rate was 7.9%. The average hospital stay was 13.23 days. Conclusion: This study showed that ketosis decompensations are still frequent. The main precipitating factors are infection and therapeutic noncompliance. Preventive actions are needed through screening programs, regular monitoring and targeted education.
文摘To determine whether mass screening of Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. Design: Single centre randomised controlled trial. Setting: All five hospitals in Viborg County, Denmark. Participants: All 12 639 men born during 1921- 33 and living in Viborg County. In 1994 we included men born 1921- 9(64- 73 years). We also included men who became 65 during 1995- 8. Interventions: Men were randomised to the intervention group(screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans. Outcome measures: Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms. Results: 4860 of 6333 men were screened(attendance rate 76.6% ). 191(4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 34% to 91% ) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84% ). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8% . The benefits of screening may increase with time. Conclusion: Mass screening of men aged 65 or more for abdominal aortic aneurysms reduces mortality.
文摘Dear Editor,Inguinal lymphadenectomy represents a crucial step in both staging and treatment of penile cancer and can be curative in some patients.Nevertheless,severe morbidity can be high in up to 50%of cases.The most-reported complications are skin necrosis,wound infection,lymphoedema,and lymphocele[1].In this setting,artery blowout syndrome(ABS)is a complication rarely described,presenting with vessels exposure through wound dehiscence,leading to arterial wall rupture with potentially life-threatening bleeding(Type III ABS).Reports have been described following radiation treatment of the groins or the neck[2,3].We present the first case of femoral artery wall rupture with severe hemorrhage after iliac and inguinal lymphadenectomy for penile cancer in a patient without previous radiation treatment.Written consent for case publication was obtained.
