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Int J Clin Pract ; 68(5): 551-6, 2014 May.
Article in English | MEDLINE | ID: mdl-24373020

ABSTRACT

A patent foramen ovale (PFO) has long been implicated as a potential mechanism for cryptogenic stroke (CS), which accounts for up to 40% of all cases of ischaemic stroke. Although there is a strong association between a PFO and CS, there is less evidence that percutaneous closure of the defect, as opposed to medical therapy with antithrombotics or anticoagulants, is the most effective form of secondary prevention. The aim of this review is to examine the evidence comparing percutaneous closure with medical therapy, with a particular focus on three recently published randomised controlled trials.


Subject(s)
Foramen Ovale, Patent/surgery , Stroke/prevention & control , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/therapy , Humans , Risk Factors , Stroke/etiology
5.
Surg Endosc ; 21(7): 1216-20, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17404791

ABSTRACT

BACKGROUND: Patients after laparoscopic Roux-en-Y gastric bypass (LRYGB) can have nonspecific, upper gastrointestinal (UGI) complaints. During postoperative endoscopy, we have noted the erosion of nondissolvable material, such as Peri-Strips or silk sutures, into the gastric pouch. This study reports the incidence and presentation of foreign material erosion into the gastric pouch after a LRYGB and the outcome after therapeutic endoscopy. METHODS: From a prospective LRYGB database, postoperative endoscopies from February 2002 to June 2005 that found foreign material in the gastric pouch were reviewed. Presenting symptoms, time until endoscopy, and patient outcomes were evaluated. A therapeutic endoscopy was performed by using endo-shears and biopsy forceps to remove the foreign material. RESULTS: A total of 23 patients underwent 29 therapeutic endoscopies. From February 2002 to November 2004, 208 LRYGB were performed using silk suture for the outer layer of the gastrojejunostomy, and 21 patients (10%) had silk suture found on endoscopy. Peri-Strips were used from February 2002 to December 2003 (n = 153) and 6 patients (4%) had erosions. Since converting to Vicryl suture and Seamguard, we have had 173 and 228 patients, respectively, without pouch erosion. The most common presenting symptom was abdominal pain (n = 15, 65%). Other symptoms included nausea (n = 13, 57%), vomiting (n = 12, 52%), dysphagia (n = 5, 22%), and melena (n = 3, 13%). Foreign material was found by a mean of 34 weeks. Of 29 therapeutic endoscopies, 20 resulted in resolution of symptoms (69%), 4 led to improvements (14%), and 5 had no effect (17%). There were no endoscopic complications and no anastomotic leaks. CONCLUSIONS: Nonabsorbable material used during a LRYGB can migrate into the gastric pouch and cause UGI complaints. A therapeutic endoscopy will resolve most UGI symptoms. Using absorbable material in the creation of the gastric pouch and the gastrojejunostomy will avoid foreign material erosion.


Subject(s)
Anastomosis, Roux-en-Y/adverse effects , Foreign-Body Migration/therapy , Gastric Bypass/adverse effects , Laparoscopy/adverse effects , Sutures/adverse effects , Adult , Anastomosis, Roux-en-Y/methods , Body Mass Index , Female , Follow-Up Studies , Foreign-Body Migration/diagnosis , Gastric Bypass/methods , Gastric Mucosa/pathology , Gastroscopy/methods , Humans , Laparoscopy/methods , Male , Middle Aged , Obesity, Morbid/diagnosis , Obesity, Morbid/surgery , Postoperative Complications/diagnosis , Retrospective Studies , Risk Assessment
6.
Atherosclerosis ; 185(2): 246-53, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16125710

ABSTRACT

OBJECTIVE: Antiphospholipid antibodies are associated with increased risk of thrombosis, particularly as in antiphospholipid syndrome. This study aims to determine the acute effects of anticardiolipin antibodies on nitric oxide production and vascular function. METHODS: Ex vivo aortic rings from male Sprague Dawley rats were incubated with IgG monoclonal anticardiolipin antibody (IS4) or a non-specific IgG control. In organ baths, response to phenylephrine and acetlycholine was determined alone and with nitro-L-arginine methyl ester (L-NAME), 1,400 W, D-arginine, L-arginine, sodium nitroprusside and cardiolipin. In vivo antibodies were injected into anaesthetised, spontaneously breathing male Sprague Dawley rats. Haemodynamic variables and serum nitric oxide were measured. Immunohistochemistry for iNOS and eNOS was performed in kidney vessels. RESULTS: Phenylepherine contraction was decreased in the IS4 group compared to controls (p < 0.001). L-NAME, 1,400 W and cardiolipin, abolished this effect. L-Arginine caused significant relaxation in the IS4 group (p = 0.005). Mean arterial pressure in rats injected with IS4 was reduced compared to IgG and saline controls (p < 0.001). NO in plasma increased significantly after IS4 administration (p < 0.001). Immunohistochemistry showed increased iNOS expression in kidney arteries in the IS4 group, with no change in eNOS. CONCLUSION: Anticardiolipin antibodies induce NO production acutely via increased expression of iNOS in both ex vivo and in vivo models.


Subject(s)
Antibodies, Anticardiolipin/pharmacology , Antibodies, Monoclonal/pharmacology , Immunoglobulin G/pharmacology , Nitric Oxide Synthase/metabolism , Animals , Antibodies, Anticardiolipin/immunology , Aorta/physiology , Blood Pressure/drug effects , Enzyme Inhibitors/pharmacology , Humans , Immunohistochemistry , In Vitro Techniques , Male , NG-Nitroarginine Methyl Ester/pharmacology , Nitric Oxide/blood , Nitric Oxide Synthase/antagonists & inhibitors , Nitric Oxide Synthase Type II/metabolism , Nitric Oxide Synthase Type III/metabolism , Phenylephrine/pharmacology , Rats , Rats, Sprague-Dawley , Renal Artery/drug effects , Renal Artery/enzymology , Renal Artery/physiology , Vasoconstriction , Vasoconstrictor Agents/pharmacology
7.
Clin Med (Lond) ; 6(6): 612-3, 2006.
Article in English | MEDLINE | ID: mdl-17228564

ABSTRACT

This report describes the case histories of three veterans who suffered cardiac arrests at the 2005 Cenotaph Remembrance Parade. All three were successfully resuscitated and admitted to the St Thomas' Hospital Coronary Care Unit. They had internal cardioverter defibrillators (ICDs) inserted and remain well. All three plan to attend Remembrance ceremonies this year. We review the evidence between emotional stress and arrhythmias and the updated National Institute for Health and Clinical Excellence (NICE) guidelines for ICDs.


Subject(s)
Heart Arrest/etiology , Stress, Psychological/complications , Aged , Aged, 80 and over , Defibrillators, Implantable , Humans , Male , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapy , Veterans , Warfare
8.
Clin Orthop Relat Res ; (345): 155-60, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9418633

ABSTRACT

Five hundred fifty-three patients undergoing hip and knee reconstructive procedures in one institution that used a patient management system were compared with a retrospective group of 340 patients undergoing similar procedures in the same institution. All procedures were performed by one surgeon and the same patient management team. Measures of length of stay, discharge disposition, and hospital charges were recorded for all patients in each subgroup of total hip arthroplasty, revision total hip arthroplasty, total knee arthroplasty, revision total knee arthroplasty, unicompartmental knee arthroplasty, and bilateral procedures. The length of stay and hospital charges were reduced significantly in all groups, whereas the percentage of patients discharged to home was unchanged. There was no significant difference in complication rates between the two groups.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Outcome Assessment, Health Care , Patient Care Management , Aftercare/economics , Aged , Arthroplasty, Replacement, Hip/economics , Arthroplasty, Replacement, Hip/rehabilitation , Arthroplasty, Replacement, Knee/economics , Arthroplasty, Replacement, Knee/rehabilitation , Cost Control , Elective Surgical Procedures , Female , Follow-Up Studies , Hospital Charges , Humans , Length of Stay , Male , Nursing Service, Hospital , Pain, Postoperative/prevention & control , Patient Admission , Patient Care Team , Patient Discharge , Patient Transfer , Preoperative Care , Reoperation , Retrospective Studies
9.
Eur Respir J ; 10(11): 2657-8, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9426111

ABSTRACT

The management of a young woman with congenital kyphoscoliosis, who developed symptomatic nocturnal hypoventilation during the third trimester of pregnancy, is described. Nasal intermittent positive pressure ventilation (NIPPV) was safely and effectively used to correct nocturnal hypoxaemia and hypercapnia from the 30th-36th week of gestation, when a healthy boy was delivered by Caesarean section. Following delivery, the mother no longer required NIPPV and returned to her prepregnancy level of activity.


Subject(s)
Hypoventilation/therapy , Intermittent Positive-Pressure Ventilation , Kyphosis/complications , Pregnancy Complications/therapy , Scoliosis/complications , Adult , Cesarean Section , Female , Humans , Hypoventilation/etiology , Infant, Newborn , Intermittent Positive-Pressure Ventilation/methods , Male , Pregnancy , Pregnancy Complications/etiology
10.
Int J Cardiol ; 62(2): 155-9, 1997 Nov 20.
Article in English | MEDLINE | ID: mdl-9431867

ABSTRACT

With the advent of antibiotics syphilis and its complications appear to have been declining as an important cause of cardiovascular disease. We describe a patient with an unusual aorto-pulmonary communication secondary to syphilitic aortitis. The case illustrates the difficulty in defining the anatomy of this rare association preoperatively. The reason for the rarity of this manifestation is discussed and finally doubt is cast upon the assumption that cardiovascular syphilis is of only historical interest.


Subject(s)
Aorta, Thoracic/abnormalities , Aortic Aneurysm, Thoracic/complications , Aortic Rupture/complications , Arterio-Arterial Fistula/etiology , Pulmonary Artery/abnormalities , Syphilis, Cardiovascular/complications , Aortic Rupture/diagnosis , Aortic Rupture/surgery , Arterio-Arterial Fistula/surgery , Chest Pain/diagnosis , Diagnosis, Differential , Ductus Arteriosus, Patent/diagnosis , Electrocardiography , Follow-Up Studies , Humans , Male , Middle Aged , Syphilis, Cardiovascular/diagnosis , Ultrasonography, Doppler, Color
11.
Physiol Behav ; 28(6): 1097-1102, 1982 Jun.
Article in English | MEDLINE | ID: mdl-7202223

ABSTRACT

Growing chicks offered diets containing either surfeit or inadequate protein in the day but adequate protein at night adopted a pattern of nocturnal feeding but did not eliminate diurnal meals. Their weight gain surpassed that of corresponding dietary controls who received continuous access to surfeit or inadequate protein but was less than that of chicks with continuous access to a standard diet. Chicks receiving the standard diet at night with no food available in the light phase also grew but did so at a slower rate than the diurnally feeding control group. The shift in feeding patterns was not accompanied by a shift in body temperature, nor was nocturnal antipredator behavior, characterized by sustained motoric inhibition, disrupted by nocturnal feeding. These data demonstrate that feeding specializations which have been selected over a species' evolutionary history are not rigidly fixed but can be modified by the economic relations in the current habitat.


Subject(s)
Animal Feed/economics , Food Preferences , Animals , Body Temperature , Body Weight , Chickens , Circadian Rhythm , Defense Mechanisms , Feeding Behavior , Humans , Time Factors
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