scholarly journals Exercise-related T-wave oversensing: an underestimated cause of reduced exercise capacity in a pacemaker-dependent patient—a case report and review of the literature

2020 ◽  
Vol 59 (1) ◽  
pp. 67-70
Author(s):  
Albert Topf ◽  
Lukas J. Motloch ◽  
Johannes Kraus ◽  
Franz Danmayr ◽  
Moritz Mirna ◽  
...  
Keyword(s):  
Intermittent Exercise ◽  
Sudden Onset ◽  
Ecg Monitoring ◽  
Review Of The Literature ◽  
T Wave ◽  
Significant Burden ◽  
Abnormal Rate ◽  
Clinically Significant ◽  
The Impact ◽  
Dependent Patient

Abstract A 62-year-old pacemaker-dependent patient presented to our department with a sudden onset of reduced physical capacity. While initial physical and pacemaker evaluations remained without specific findings, Holter-ECG monitoring revealed an abnormal rate response with unusual pauses during physical exercise. Consequently, closer evaluation of the pacemaker system revealed intermittent, exercise-related T-wave oversensing (TWOS). While TWOS remains a significant burden in ICD-patients, it might be an underestimated but clinically significant event in pacemaker patients. Further studies should evaluate the impact of TWOS in this patient population.

Theophylline and Verapamil: Clinically Significant Drug Interaction

1997 ◽  
Vol 13 (6) ◽  
pp. 241-243
Author(s):  
Luella Bangura ◽  
Mark A Malesker ◽  
Naresh A Dewan
Keyword(s):  
Drug Interaction ◽  
Chest Pain ◽  
Adverse Effects ◽  
Clinical Significance ◽  
Sudden Onset ◽  
Review Of The Literature ◽  
Theophylline Clearance ◽  
Significant Drug Interaction ◽  
Case Summary ◽  
Clinically Significant

Objective: To report and describe a case of verapamil interacting with theophylline. Case Summary: A 33-year-old white man with bronchial asthma was admitted for evaluation of sudden onset of chest pain. During hospitalization, verapamil 120 mg/d was added to the theophylline regimen (600 mg bid). The patient's requirement for theophylline decreased by 50% after the initiation of verapamil. Discussion: A review of the literature indicated that concomitant verapamil may reduce theophylline clearance by 12–23%. Other reports suggest that the degree of this interaction is of much smaller magnitude and clinically insignificant. Conclusions: Although the most recent FDA labeling guidelines for theophylline mention verapamil as a documented source of drug interaction with theophylline, many clinicians may not realize the potential clinical significance. Therefore, theophylline concentrations should be monitored in patients receiving both theophylline and verapamil, even in the absence of adverse effects.

Stages of the formation of temporary and permanent occlusion and the impact of early tooth extraction on the dentition state. Literature review

2019 ◽  
pp. 22-24
Author(s):  
G.A. Murachueva ◽  
I.M. Rasulov ◽  
S.G. Gusenov
Keyword(s):  
Literature Review ◽  
Temporomandibular Joint ◽  
Tooth Extraction ◽  
Physiological State ◽  
Review Of The Literature ◽  
Full Development ◽  
Permanent Occlusion ◽  
The Impact

A review of the literature on the stages of the formation of temporary and permanent occlusion has been performed. This stages play an important role not only for the full development of the maxillofacial apparatus, temporomandibular joint, but also the whole organism. The role of early tooth extraction in the formation of the physiological state of the dentoalveolar system is considered. The conclusion is drawn about the need for a deeper study of this problem in the structure of general dental morbidity.

Meconium peritonitis: review of literature and own clinical observations

2020 ◽  
Author(s):  
E.N. Glavatskaya , O.V. Pribushenya , N.A. Venchikova
Keyword(s):  
Prenatal Diagnosis ◽  
Premature Birth ◽  
Surgical Care ◽  
Intestinal Wall ◽  
Meconium Peritonitis ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Clinical Observations ◽  
Loop Expansion ◽  
The Impact

Two clinical cases of meconium peritonitis in the fetuses are presented. The diagnosis was made prenatally at 30+5 and 20+1 weeks of gestation. The main ultrasound signs were ascites, loop expansion and thickening of the intestinal wall, peritoneal calcifications, meconium pseudocysts. In one case, pregnancy was complicated by polyhydramnios. In both cases, the pregnancy ended in premature birth, followed by surgical treatment during the first days of life. A review of the literature on the topic are discussed the etiology, the spectrum and frequency of ultrasound signs suggesting this condition in the fetus, the effectiveness of prenatal diagnosis, the prognosis for the life and health of the newborn, as well as the impact of the quality and timeliness of the prenatal diagnosis on the management of pregnancy and timeliness of surgical care for the newborn.

Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

2019 ◽  
Vol 17 (2) ◽  
pp. 180-190 ◽  
Author(s):  
V. Katsi ◽  
G. Georgiopoulos ◽  
D. Oikonomou ◽  
C. Aggeli ◽  
C. Grassos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Antihypertensive Agents ◽  
Renin Angiotensin System ◽  
Aortic Disease ◽  
Review Of The Literature ◽  
Angiotensin System ◽  
The Impact ◽  
Worse Prognosis

Background: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. </P><P> Objective: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. </P><P> Methods: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. </P><P> Results: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. </P><P> Conclusion: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

scholarly journals The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew G. Hanson ◽  
Barry Chan
Keyword(s):  
Pericardial Effusion ◽  
Point Of Care ◽  
Physical Exam ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Average Systolic Blood Pressure ◽  
Time To Diagnosis ◽  
Clinically Significant ◽  
The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

scholarly journals Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors

2021 ◽  
Vol 10 (5) ◽  
pp. 1141
Author(s):  
Gianpaolo Marte ◽  
Andrea Tufo ◽  
Francesca Steccanella ◽  
Ester Marra ◽  
Piera Federico ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Liver Metastases ◽  
Meta Analysis ◽  
Multidisciplinary Treatment ◽  
Review Of The Literature ◽  
Term Survival ◽  
The Impact

Background: In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. Methods: The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. Results: We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1–2 and pN0–1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. Conclusion: In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.

scholarly journals Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 691
Author(s):  
Jan Barcik ◽  
Devakara R. Epari
Keyword(s):  
Fracture Healing ◽  
Bone Healing ◽  
Mechanical Stimulation ◽  
Callus Formation ◽  
Weight Bearing ◽  
Healing Process ◽  
Healing Time ◽  
Mechanical Environment ◽  
Clinically Significant ◽  
The Impact

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

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