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Objectives: Aortic valve repair can be limited by inadequate leaflet tissue for proper coaptation. Various kinds of pericardium have been used for cusp augmentation, but most have failed because of tissue degeneration. A more durable leaflet substitute is needed. Methods: In this report, 8 consecutive cases are presented in which autologous ascending aortic tissue was used to augment inadequate native cusps during aortic valve repair. Biologically, aortic wall is a living autologous tissue that could have exceptional durability as a leaflet substitute. Techniques for insertion are described in detail, along with procedural videos. Results: Early surgical outcomes were excellent, with no operative mortalities or complications, and all valves were competent with low valve gradients. Patient follow-up and echocardiograms to a maximum of 8 months' postrepair remain excellent. Conclusions: Because of superior biologic characteristics, aortic wall has the potential to provide a better leaflet substitute during aortic valve repair and to expand patient categories amenable to autologous reconstruction. More experience and follow-up should be generated.
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BACKGROUND: Robotic mitral valve surgery has potential advantages in patient satisfaction and 30-day outcome. Cost concerns and repair durability limit wider adoption of robotic technology. This study examined detailed cost differences between robotic and sternotomy techniques in relation to outcomes and durability following robotic mitral program initiation. METHODS: Between April 2013 and October 2015, 30-day and 1-year outcomes of 328 consecutive patients undergoing robotic or sternotomy mitral valve repair or replacement by experienced surgeons were examined. Multivariable logistic regression informed propensity matching to derive a cohort of 182 patients. Echocardiographic follow-up was completed at 1 year in all robotic patients. Detailed activity-based cost accounting was applied to include direct, semidirect, and indirect costs with special respect to robotic depreciation, maintenance, and supplies. A quantitative analysis of all hospital costs was applied directly to each patient encounter for comparative financial analyses. RESULTS: Mean predicted risk of mortality was similar in both the robotic (n = 91) and sternotomy (n = 91) groups (0.9% vs 0.8%; P > .431). The total costs of robotic mitral operations were similar to those of sternotomy ($27,662 vs $28,241; P = .273). Early direct costs were higher in the robotic group. There was a marked increase in late indirect cost with the sternotomy cohort related to increased length of stay, transfusion requirements, and readmission rates. Robotic repair technique was associated with no echocardiographic recurrence greater than trace to only mild regurgitation at 1 year. CONCLUSIONS: Experienced mitral surgeons can initiate a robotic program in a cost-neutral manner that maintains clinical outcome integrity as well as repair durability.
Assuntos
Análise Custo-Benefício , Implante de Prótese de Valva Cardíaca/métodos , Custos Hospitalares/estatística & dados numéricos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Esternotomia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/economia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral/economia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/economia , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , West VirginiaRESUMO
Neste artigo está descrito um programa de tratamento grupal intensivo para casais que sofrem de doenças psiquiátricas não psicóticas, disfunções de personalidade e/ou problemas complexos de relacionamento conjugal. Geralmente, um dos parceiros tem uma longa história de atendimento na saúde mental. Esta história de intervenções geralmente inclui ao menos algumas sessões de terapia conjugal, entretanto sem sucesso suficiente. Estes casais são parte de um grupo de pacientes da saúde mental que pode ser descrito, ou se descreve como: "tudo foi feito, mas nada realmente ajudou. O programa de tratamento grupal intensivo iniciou em 1991 e, até fevereiro de 2004, 415 casais foram tratados em 91 grupos. Apesar do Centro para Problemas Relacionais estar situado em uma área rural do nordeste da Holanda, os casais são encaminhados de todo o país. Isso demonstra que é necessário um tratamento intensivo para casais em um setting de internação. Além disso, pelo menos no que se sabe, esse tipo de tratamento não existe em outro lugar do mundo. Nesse artigo serão apresentados detalhes do programa e a lógica que o sustenta.(AU)
In this paper we elaborate on an inpatient clinical group program for couples suffering from non-psychotic psychiatric disorders, personality disorders and/or complex partner relational problems. In general one of the partners has a long history in mental health care. The intervention history often includes at least some sessions of couple therapy, but without sufficient success. These couples are part of that group of mental health patients that can be described as, or describe themselves as: everything was done but nothing really helped. The clinical inpatient couple group program was initiated in 1991 and to date (February 2004) 415 couples have been treated in 91 groups. Although our Center for Relational Problems is situated in a rural area in the northern part of the Netherlands, these couples are referred from all over the country. This proves that there is a need for highly intensive couple treatment in an inpatient setting. Nevertheless, as far as we know, this type of treatment does not exist anywhere else in the world. In this paper we will give details of the program and the rationale behind it.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Terapia de CasalRESUMO
Neste artigo está descrito um programa de tratamento grupal intensivo para casais que sofrem de doenças psiquiátricas não psicóticas, disfunções de personalidade e/ou problemas complexos de relacionamento conjugal. Geralmente, um dos parceiros tem uma longa história de atendimento na saúde mental. Esta história de intervenções geralmente inclui ao menos algumas sessões de terapia conjugal, entretanto sem sucesso suficiente. Estes casais são parte de um grupo de pacientes da saúde mental que pode ser descrito, ou se descreve como: "tudo foi feito, mas nada realmente ajudou. O programa de tratamento grupal intensivo iniciou em 1991 e, até fevereiro de 2004, 415 casais foram tratados em 91 grupos. Apesar do Centro para Problemas Relacionais estar situado em uma área rural do nordeste da Holanda, os casais são encaminhados de todo o país. Isso demonstra que é necessário um tratamento intensivo para casais em um setting de internação. Além disso, pelo menos no que se sabe, esse tipo de tratamento não existe em outro lugar do mundo. Nesse artigo serão apresentados detalhes do programa e a lógica que o sustenta.
In this paper we elaborate on an inpatient clinical group program for couples suffering from non-psychotic psychiatric disorders, personality disorders and/or complex partner relational problems. In general one of the partners has a long history in mental health care. The intervention history often includes at least some sessions of couple therapy, but without sufficient success. These couples are part of that group of mental health patients that can be described as, or describe themselves as: everything was done but nothing really helped. The clinical inpatient couple group program was initiated in 1991 and to date (February 2004) 415 couples have been treated in 91 groups. Although our Center for Relational Problems is situated in a rural area in the northern part of the Netherlands, these couples are referred from all over the country. This proves that there is a need for highly intensive couple treatment in an inpatient setting. Nevertheless, as far as we know, this type of treatment does not exist anywhere else in the world. In this paper we will give details of the program and the rationale behind it.
Assuntos
Humanos , Masculino , Feminino , Adulto , Terapia de CasalRESUMO
The aim of this paper is to review the literature on the frequency of cancers to develop priorities for cancer policy, prevention, services and research for black and minority ethnic populations in Britain. Data on populations originating in the Indian sub-continent, and Caribbean and African Commonwealth were extracted from published works. Cancers were ranked (top seven) on the basis of the number of cases, actual frequency, and also on relative frequency (SMR, SRR, PMR). Cancer was found to be a common cause of death. For example, during 1979-83 the proportion of death resulting from neoplasms in immigrants living in England and Wales was 11 percent for Indian and African men aged 20-49, and 19 percent for Caribbeans. The corresponding proportions were higher among women. The pattern of cancer depended on the method used to assess rankings. On the basis of the number of cases the top 3 ranking cancers for adults were breast, lung and neoplasms of the lymphatic system. Based on SMR's cancer of the gall bladder, liver and oral cavity ranked amongst the top 3 for adults. For children the top ranking cancers were acute lymphoblastic leukaemia, central nervous system tumours and neuroblastoma. Variations by ethnic groups were more evident in the rankings of relative frequency than in rankings based on numbers of cases. In conclusion, the most common and preventable cancers among minority ethnic populations were the same as those for the general population. The different cancer pattern based on SMRs highlight additional needs and provide potential models for research into understanding the causes of these cancers. Health services policy and practice should ensure that the common and preventable cancers take priority over rare cancers and those for which there is no effective treatment or prevention. Priorities for policy, prevention, clinical care and research should be set separately, for they differ. (AU)
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Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Criança , Etnicidade/estatística & dados numéricos , Planejamento em Saúde , Grupos Minoritários/estatística & dados numéricos , Neoplasias/epidemiologia , Reino Unido/epidemiologiaRESUMO
Most reports concerning the use of streptokinase (SK) for thrombolysis in myocardial infarction (MI) have employed doses over 1,000,000 units. We evaluated the efficacy of a dose of 500,000 U in 40 patients with acute MI who received full heparin dose before, during and after SK. Thrombolytic effect, as measured by the protamine neutralized thrombin time was shown to be strong in 60% of cases, moderate in 17% and weak in 22%, and this was not modified by larger SK doses. A patent culprit artery was demonstrated at coronary arteriography performed 3 days after SK in 90% of patients. Only one instance of severe bleeding was observed. Thus, a reduced SK dose in association to heparin provides adequate lytic effect and artery patency rate in patients with MI.
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Fibrinolíticos/administração & dosagem , Heparina/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Estreptoquinase/administração & dosagem , Terapia Trombolítica , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estreptoquinase/efeitos adversosRESUMO
Five workers at a precious metal refinery developed granulomatous lung disease between 1972 and 1985. The original diagnosis was sarcoidosis, but 4 of the workers were subsequently proved to have hypersensitivity to beryllium by in vitro proliferative responses of lymphocytes obtained by bronchoalveolar lavage. Review of medical records of coworkers and extensive industrial hygiene surveillance of the plant demonstrated that 4 cases occurred in the furnace area where air concentrations of beryllium fume were consistently below the permissible exposure limit of 2 micrograms/M3. A single case has been recognized from parts of the refinery where exposures to cold beryllium dust often exceeded the standard by as much as 20-fold. These data demonstrate that chronic beryllium disease still occurs and confirm the importance of specific immunologic testing in patients suspected of having sarcoidosis but with potential exposure to beryllium. The data raise concern about the adequacy of modern industrial controls, especially in the setting of exposure to highly respirable beryllium fume.
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Beriliose/epidemiologia , Metalurgia , Adulto , Poluentes Ocupacionais do Ar/análise , Beriliose/imunologia , Beriliose/patologia , Berílio/análise , Biópsia , Doença Crônica , Connecticut , Poeira/análise , Hispânico ou Latino , Humanos , Pulmão/imunologia , Pulmão/patologia , Masculino , Porto Rico/etnologia , Risco , Linfócitos T/imunologiaRESUMO
This paper reports further detailed measurements of strong radio pulses from the pulsar NP 0532 in the Crab nebula, recorded at Arecibo.