Objective Our objectives were to document the preoperative and postoperative f unctional status of patients undergoing coronary artery bypass grafting, to exam ine factors that influence functional recovery, and to de...Objective Our objectives were to document the preoperative and postoperative f unctional status of patients undergoing coronary artery bypass grafting, to exam ine factors that influence functional recovery, and to determine whether gender differences exist in the preoperative and postoperative functional status with t he Duke Activity Status Index. Methods One thousand eight hundred twenty five p atients undergoing isolated coronary artery bypass grafting had baseline and fol low up quality of life surveys. Mean follow up from baseline to postoperativ e Duke Activity Status Index was 8.0 months for women and men. The influence of 47 variables, in addition to baseline scores on postoperative functional status, was examined with logistic ordinal modeling. An ordinal model for the follow u p score was determined by means of backward selection, with variables retained i f they satisfied the criterion of a P value of less than .05. Results Median baseline Duke Activity Status Index scores (women, 21 .5; men, 32.2; P< .001) and first follow up scores (women, 42.7; men, 58.2; P< .001) were lower in women than in men. Patients who were older and those who had chronic obstructive pulmonary disease, myocardial infarction, stroke, diabetes, vascular disease, postoperative serious infection, and return to the operating room had lower postoperative scores. After adjusting for these factors, women st ill had lower follow up scores (odds ratio for men, 2.1 [95%confidence interv a l, 1.7-2.6]; P< .001). Conclusions A number of preoperative factors, operative variables, and postoperative events are associated with functional recovery afte r coronary revascularization. In addition, female gender is associated with more postoperative functional impairment after adjusting for these perioperative var iables.展开更多
Background-Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient’s body surface area. The relation between prosthesis-patient size and functional cap...Background-Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient’s body surface area. The relation between prosthesis-patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement,continuous prosthesis-patient size, and other factors on functional recovery after aortic valve replacement(AVR) with the Duke Activity Status Index(DASI). Methods and Results-From June 15, 1995, through May 14, 1998, 1108 patients underwent AVR after completing a DASI survey. Of these, 1014 completed a postoperative DASI survey at an average of 8.3 months postoperatively. Logistic ordinal regression was used to examine the influence of demographic variables, comorbidities, baseline DASI scores, indexed valve orifice area, standardized orifice size, and postoperative morbid events on postoperative DASI. There was overall improvement in postoperative functional recovery reflected by median preoperative and postoperative DASI scores of 29 and 46, P< 0.001, respectively. Neither indexed orifice area, P=0.94, nor standardized orifice size, P=0.96, was associated with functional recovery. Female sex, increasing age, elevated serum creatinine, increased central venous pressure, and red blood cell transfusion were factors associated with poor postoperative functional recovery. Conclusions-A majority of patients report improvement in functional quality of life early after AVR. Similar functional recovery was demonstrated for patients along the full spectrum of valve sizes indexed to body size, even for values considered to represent severe mismatch for patient size. Factors other than prosthesis-patient size influence functional quality of life early after AVR.展开更多
Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in ...Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in support of this theory. To assess prospectively the rate of manometric progression of DES to achalasia. Manometry tracings of DES patients diagnosed between 1992 and 2003 were independently reviewed blindly and agreed on by two esophageal experts. Patients with DES who agreed to undergo repeat esophageal manometry constituted the study cohort. Follow- up manometry tracings were evaluated blindly and independently by the same two interpreters to determine the rate of manometric progression to achalasia. Predictors of manometric progression were assessed. A total of 32 patients were diagnosed with DES between 1992- 2003. Twelve patients (9M/3F;median age 62 years) agreed to participate and underwent second manometry (mean ± SD follow- up of 4.8± 3.4 years). Achalasia was diagnosed on follow- up manometry in one patient (8% ), seven (58% ) patients continued to have DES, three (25% ) had normal motility, and one (8% ) had nutcracker esophagus. There were no predictors of progression to achalasia based on the initial manometry parameters. A subgroup of DES patients with initial low esophageal body amplitude developed increase in esophageal simultaneous contractions on follow- up similar to the patient who evolved to achalasia. Following were the results. 1) Progression from DES to achalasia is uncommon. 2)DES patients with low esophageal body amplitude may develop increased simultaneous contractions over time. 3) DES remains an elusive diagnosis clinically and manometrically.展开更多
文摘Objective Our objectives were to document the preoperative and postoperative f unctional status of patients undergoing coronary artery bypass grafting, to exam ine factors that influence functional recovery, and to determine whether gender differences exist in the preoperative and postoperative functional status with t he Duke Activity Status Index. Methods One thousand eight hundred twenty five p atients undergoing isolated coronary artery bypass grafting had baseline and fol low up quality of life surveys. Mean follow up from baseline to postoperativ e Duke Activity Status Index was 8.0 months for women and men. The influence of 47 variables, in addition to baseline scores on postoperative functional status, was examined with logistic ordinal modeling. An ordinal model for the follow u p score was determined by means of backward selection, with variables retained i f they satisfied the criterion of a P value of less than .05. Results Median baseline Duke Activity Status Index scores (women, 21 .5; men, 32.2; P< .001) and first follow up scores (women, 42.7; men, 58.2; P< .001) were lower in women than in men. Patients who were older and those who had chronic obstructive pulmonary disease, myocardial infarction, stroke, diabetes, vascular disease, postoperative serious infection, and return to the operating room had lower postoperative scores. After adjusting for these factors, women st ill had lower follow up scores (odds ratio for men, 2.1 [95%confidence interv a l, 1.7-2.6]; P< .001). Conclusions A number of preoperative factors, operative variables, and postoperative events are associated with functional recovery afte r coronary revascularization. In addition, female gender is associated with more postoperative functional impairment after adjusting for these perioperative var iables.
文摘Background-Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient’s body surface area. The relation between prosthesis-patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement,continuous prosthesis-patient size, and other factors on functional recovery after aortic valve replacement(AVR) with the Duke Activity Status Index(DASI). Methods and Results-From June 15, 1995, through May 14, 1998, 1108 patients underwent AVR after completing a DASI survey. Of these, 1014 completed a postoperative DASI survey at an average of 8.3 months postoperatively. Logistic ordinal regression was used to examine the influence of demographic variables, comorbidities, baseline DASI scores, indexed valve orifice area, standardized orifice size, and postoperative morbid events on postoperative DASI. There was overall improvement in postoperative functional recovery reflected by median preoperative and postoperative DASI scores of 29 and 46, P< 0.001, respectively. Neither indexed orifice area, P=0.94, nor standardized orifice size, P=0.96, was associated with functional recovery. Female sex, increasing age, elevated serum creatinine, increased central venous pressure, and red blood cell transfusion were factors associated with poor postoperative functional recovery. Conclusions-A majority of patients report improvement in functional quality of life early after AVR. Similar functional recovery was demonstrated for patients along the full spectrum of valve sizes indexed to body size, even for values considered to represent severe mismatch for patient size. Factors other than prosthesis-patient size influence functional quality of life early after AVR.
文摘Diffuse esophageal spasm (DES) and achalasia share both clinical and manometric characteristics. Some reports support the notion of progression of DES to achalasia. However, there are currently no prospective data in support of this theory. To assess prospectively the rate of manometric progression of DES to achalasia. Manometry tracings of DES patients diagnosed between 1992 and 2003 were independently reviewed blindly and agreed on by two esophageal experts. Patients with DES who agreed to undergo repeat esophageal manometry constituted the study cohort. Follow- up manometry tracings were evaluated blindly and independently by the same two interpreters to determine the rate of manometric progression to achalasia. Predictors of manometric progression were assessed. A total of 32 patients were diagnosed with DES between 1992- 2003. Twelve patients (9M/3F;median age 62 years) agreed to participate and underwent second manometry (mean ± SD follow- up of 4.8± 3.4 years). Achalasia was diagnosed on follow- up manometry in one patient (8% ), seven (58% ) patients continued to have DES, three (25% ) had normal motility, and one (8% ) had nutcracker esophagus. There were no predictors of progression to achalasia based on the initial manometry parameters. A subgroup of DES patients with initial low esophageal body amplitude developed increase in esophageal simultaneous contractions on follow- up similar to the patient who evolved to achalasia. Following were the results. 1) Progression from DES to achalasia is uncommon. 2)DES patients with low esophageal body amplitude may develop increased simultaneous contractions over time. 3) DES remains an elusive diagnosis clinically and manometrically.
