Cardiac and plasma activities of marker lysosomal enzymes were studied in Wistar rats with metabolic (epinephrine) and occlusion (ligation of coronary arteries) myocardial infarction. Activity of all examined lysosomal enzymes significantly increased in the myocardium and blood plasma starting from the first day after ligation of the coronary arteries and was accompanied by leukocytic infiltration of the myocardium. Enzyme activity gradually decreased to postoperation day 14. In metabolic infarction leukocytic infiltration and specific activity of lysosomal enzymes rose gradually and attained maximum to postoperation day 14, while the signs of labilization of lysosomal membranes appeared from the first postoperation day. Plasma activity of lysosomal enzymes in metabolic infarction increased smoothly and peaked on day 14.
The level of arterial ligation has been a variable of the Swedish Colorectal Cancer Registry since 2007. The aim of this study is to evaluate the accuracy of this registry variable in relation to anterior resection for rectal cancer.
The operative charts of all cardiovascularly compromised patients who underwent anterior resection during the period 2007-2010 in Sweden were retrieved and compared to the registry. We selected the study population to reflect the common assumption that these patients would be more sensitive to a compromised visceral blood flow. Levels of vascular ligation were defined, both oncologically and functionally, and their sensitivity, specificity, positive and negative predictive values, level of agreement and Cohen's kappa were calculated.
Some 744 (94.5%) patients were eligible for analysis. Functional high tie level showed a sensitivity of 80.2% and a specificity of 90.1%. Positive and negative predictive values were 87.7 and 83.8%, respectively. Level of agreement was 85.5% and Cohen's kappa 0.70. The corresponding calculations for oncologic tie level yielded similar results.
The suboptimal validity of the Swedish Colorectal Cancer Registry regarding the level of vascular ligation might be problematic. For analyses with rare positive outcomes, such bowel ischaemia, or with minor expected differences in outcomes, it would be beneficial to collect data directly from the operative charts of the medical records in order to increase the chance of identifying clinically relevant differences.
OBJECTIVE. To assess the incidence rate of cervical incompetence diagnoses in Denmark 1980-1990 according to maternal age, to analyse regional variations, to investigate how often cerclage is applied, and finally to estimate abortion rates among women with cervical incompetence with and without cerclage. DESIGN. A register-based retrospective cross section study. SETTING. All Danish gynecological departments. MATERIAL AND METHODS. Since 1977, all hospitalized patients in Denmark have been centrally recorded by diagnosis according to the ICD classification and by operation codes in The National Patient Register. From this database, all women with cervical incompetence (CI) and cerclage in the period 1980-1990 were identified. From the same database all cases of spontaneous abortions were registered. RESULTS. A total of 2756 cases of cervical incompetence were registered in the period 1980-1990, corresponding to an incidence rate of 4.6/1000 births. The risk of cervical incompetence increased from 2/1000 births among women 15-19 years old to 7.5/1000 births among women 35-39 years old. The incidence rate of the CI-diagnosis fell 44% from 1980 to 1990. The incidence rates in different counties ranged from 1.7/1000 births to 10.0/1000 births. The average length of stay in hospital among patients with cervical incompetence was three weeks. Among patients with cervical incompetence, 61% were treated with cerclage. This per cent increased from 29% among women 15-19 years old to 68% among women 35-39 years old. 13.5% of women with CI experienced spontaneous abortion. This percentage increased from 12% for women 15-19 years old to 17% among women 40-44 years old (p
The objective of this analysis was to assess the incidence rate of cervical incompetence diagnoses in Denmark 1980-1990 according to maternal age, to analyze regional variations, to investigate how often cervical cerclage is applied, and finally to estimate abortion rates among women with cervical incompetence with and without cervical cerclage. The design was a register-based retrospective cross sectional study, including all Danish gynaecological departments. Since 1977, all hospitalized patients in Denmark have been centrally recorded by diagnosis according to the ICD classification and by operation codes in The National Patient Register. From this database, all women with cervical incompetence (CI) and cerclage in the period 1980-1990 were identified. From the same database all cases of spontaneous abortions were registered. A total of 2756 cases of cervical incompetence were registered in the period 1980-1990, corresponding to an incidence rate of 4.6/1000 births. The risk of cervical incompetence increased from 2/1000 births among women 15-19 years old to 7.5/1000 births among women 35-39 years old. The incidence rate of the CI-diagnosis fell by 44% from 1980 to 1990. The incidence rates in different counties ranged from 1.7/1000 births to 10.0/1000 births. The average length of stay in hospital among patients with cervical incompetence was three weeks. Among patients with cervical incompetence, 61% were treated with cervical cerclage. This percentage increased from 29% among women 15-19 years old to 68% among women 35-39 years old. 13.5% of women with CI experienced spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)
Although there have been a few case reports in the literature of self-inflicted symptoms presenting as complex regional pain syndrome (CRPS), there has been no systematic study. This report investigates the period prevalence and characteristics of self-induced disorders in patients referred to a comprehensive pain clinic with a diagnosis of CRPS.
Retrospective chart review was conducted for all cases referred as "neuropathic pain" to a comprehensive pain clinic over a period of 2 years.
Out of 175 consecutive neuropathic pain referrals over a 2-year period, 41 were specifically referred as CRPS. Application of (modified) 1994 IASP CRPS criteria confirmed the diagnosis of CRPS in 11/15 men and in 15/26 women. Four of the 15 women had evidence of active self-induced signs and symptoms (eg, ligation of the limb, ulcerations, bizarre migrating wounds), which abated with casting, strict observation, discussion with the patient, or other intervention. The characteristics of these cases are presented and compared with other similar cases seen in previous years.
This is the first report of a case series of patients diagnosed as CRPS with self-induced symptoms. We discuss in detail limitations of the study, factors that contribute to the index of suspicion, and the complex nature of the behavior including the overlap between factitious disorder, somatoform disorders, and malingering, whereas we stress the legitimacy of CRPS as a diagnosis.
Superficial venous reflux and varicose veins are common. The aim of this randomized controlled trial was to assess effectiveness of compression therapy compared with surgery for superficial venous reflux.
153 patients with CEAP class C2-C3 and superficial venous reflux were randomized to receive either conservative treatment (compression stockings) (n = 77) or surgery (n = 76). Clinical examination including duplex ultrasound (DUS) was performed at entry and 1 and 2 years after randomization (compression group) or surgery (surgery group). Venous Clinical Severity Score without compression stockings (VCSS-S), Venous Segmental Disease Score (VSDS), Venous Disability Score (VDS), and health-related quality of life (HRQoL) were assessed at entry and at the follow-ups. Data were analysed on an intention-to-treat basis and according to the actual treatment performed.
At 2 years, 70/76 patients in the surgery group and 11/77 patients in the compression group had been operated on. VCSS-S decreased from 4.6 to 3.5 in the compression group (p
To study coronary artery (CA) perfusion and myocardial performance after patent ductus arteriosus (PDA) ligation. The postoperative course in premature infants undergoing surgical ligation of PDA is often complicated by cardiorespiratory instability secondary to impaired left ventricular performance.
Serial echocardiography was performed before and after (1, 8, and 24 hours) PDA ligation to assess systolic (left ventricular output [LVO]) and diastolic (isovolumic relaxation time, E and A wave peak velocity) myocardial performance, and CA diastolic flow (CA velocity time integral and flow). The ratio of CA flow to LVO was calculated as a surrogate of coronary flow.
A total of 20 infants (gestational age at birth, 26.3 ± 0.7 weeks) requiring PDA ligation at a median of 28.5 days (range, 9-40) after birth and weight of 780 g (range, 570-2840) were studied. A postoperative increase in the CA flow/LVO ratio was demonstrated. An early decrease in E and A wave peak velocity (P
Hemodynamical changes in coarctation were studied with an experimental model. Coarctation of the thoracic aorta was induced in seven puppies at the age of 8 wk. After a 7-month follow-up period a corrective operation with a venous patch was performed. Two dogs were lost a few hours after the correction operation. The remaining five dogs were followed for 12 months postoperatively. Renal perfusion was measured with a 133Xenon washout method just prior to the operation, 1 h, 6 and 12 months postoperatively. The glomerular filtration rate was measured using the 51Cr-EDTA method 1 wk before the operation, 3 wk, 2, 6, and 12 months after it. Six healthy adult dogs were used as controls for glomerular filtration rate measurements. Peripheral renin activity was measured at operation, just before the correction of aortic coarctation, 1/2, 1 h, 1, 3, 7 days, 2 and 6 months after the correction operation. Renal perfusion decreased significantly (p less than 0.05) immediately after the correction operation and rose again during the follow-up. Peripheral renin activity rose significantly (p less than 0.01) from the preoperative values and was at its greatest 1 day after the operation. Later on, peripheral renin activity values returned to normal. Coarctated dogs had significantly (p less than 0.01) lower glomerular filtration rate values than controls in each measurement except at the 2 months postoperative measurement. These results support decreased renal perfusion with resultant increased peripheral renin activity as part of the pathomechanism of the paradoxical hypertension observed after correction of coarctation.
An experimental model of right heart failure was developed to determine the effects of fluid loading and aminophylline on right heart function. We hypothesised that aminophylline would specifically improve right heart function through a decrease in pulmonary vascular resistance and, possibly, an increase in cardiac contractility. Right heart infarct was induced in ten experimental pigs and seven control pigs by ligating branches of the right coronary artery. The effect of fluid loading with a colloid solution and subsequent bolus doses of aminophylline on haemodynamics was observed. Fluid loading improved haemodynamics as expected. Aminophylline transiently improved cardiac index and pulmonary vascular resistance, but simultaneously caused an increase in heart rate and a decrease in stroke volume. Although aminophylline may reduce right heart afterload, it did not improve overall cardiac function in this experimental model of right heart infarction.