Purpose: To describe the baseline data of a large cohort of patients included for follow-up with perimetry using the frequency doubling technique (FDT) and w ith quantification of the retinal nerve fibre layer as asse...Purpose: To describe the baseline data of a large cohort of patients included for follow-up with perimetry using the frequency doubling technique (FDT) and w ith quantification of the retinal nerve fibre layer as assessed by GDx, and to c alculate the sensitivity and specificity of both devices from these baseline dat a. Methods: Regular visitors to our glaucoma service were included. All subjects were followed for at least 4 years with FDT in full-threshold mode, GDx and co nventional perimetry. Patients were classified as having either glaucoma or susp ect glaucoma, according to baseline perimetry results. In addition, a group of h ealthy subjects was recruited outside the hospital. Results: A total of 452 glau coma patients, 423 glaucoma suspects and 237 healthy subjects were incorporated into the analyses. Sensitivities for both FDT and GDx were fixed at 0.90. For th e group as a whole, the specificity was 0.81 for FDT, using number of depressed test-points p <0.01 in the total deviation probability plot with a cut-off poi nt >1, and 0.78 for GDx, using the Number, with a cut-off point >29. The area u nder the receiver operating characteristic (ROC)curve was 0.92 for FDT and 0.94 for GDx. Of the subjects with suspect glaucoma, 75%showed normal FDT test resul ts and 52%showed normal GDx results. Unlike FDT, GDx failed to detect some mode rate/severe glaucoma cases. Conclusions: The performances of FDT and GDx are app roximately equivalent in terms of sensitivity, specificity and area under the RO C curve. In glaucoma suspects, GDx in particular yielded a rather high percentag e of positive test results. The majority of these positive test results are pres umably false-positive results rather than results indicating preperimetric glau coma.展开更多
Purpose: To develop an algorithm for the scoring of frequency doubling perimery (FDT) test results based on a statistical analysis of the distribution of the localisation of defects in glaucoma patients and normals, a...Purpose: To develop an algorithm for the scoring of frequency doubling perimery (FDT) test results based on a statistical analysis of the distribution of the localisation of defects in glaucoma patients and normals, and to compare the performance of the new algorithm and all previously published algorithms in a glaucoma service based screening setting. Methods: The right eye展开更多
Purpose: To clarify the discrepancy found in literature about a possible learning effect in frequency doubling perimetry (FDT) by measuring the learning effect in a large group of subjects of various ages, with and wi...Purpose: To clarify the discrepancy found in literature about a possible learning effect in frequency doubling perimetry (FDT) by measuring the learning effect in a large group of subjects of various ages, with and without perimetric experience, and with and without glaucoma Methods: Two FDT measurements were performed in three groups: young normals without perimeric experience (group I, n =26), aged normals without perimetric ex-展开更多
Objectives This study aimed to investigate the prognostic importance of plasma erythropoietin(EPO) levels in chronic heart failure (CHF) patients. Background Anemia is common and is associated with an impaired surviva...Objectives This study aimed to investigate the prognostic importance of plasma erythropoietin(EPO) levels in chronic heart failure (CHF) patients. Background Anemia is common and is associated with an impaired survival in patients with CH F. Erythropoietin is a hematopoietic growth factor, upregulated in anemic condit ions. Little is known about the pathophysiology of anemia in CHF and the prognos tic importance of plasma EPO levels in CHF patients. Methods In 74 patients with CHF(age, 61±2 years; left ventricular ejection fraction,0.31±0.01; peak oxyge n consumption, 19.1±0.6 <<mean±SEM>>) and in 15 control patients, hemoglobin lev els and plasma concentrations of EPO and brain natriuretic peptide were measured . Results During a mean follow-up of 3.0 years (range, 2.3 to 5.3 years), 22 pa tients (30%) died. Anemia was present in 24%of the patients. Multivariate anal ysis showed that plasma EPO(p =0.026) and hemoglobin levels (p=0.005) were indep endent predictors of survival in this CHF population. We observed only a mild in verse correlation between the logarithm of EPO and hemoglobin levels (r2=0.08, p =0.02) in CHF patients,whereas the control group showed a clear significant inve rse correlation (r2=0.44, p=0.007). Conclusions Elevated plasma EPO levels are a ssociated with an impaired prognosis independent of hemoglobin levels and other established markers of CHF severity. Furthermore, in the CHF patients, EPO level s poorly correlate with the hemoglobin levels, in contrast with the control grou p.展开更多
PURPOSE: To study the discriminatory ability of dacryoscin-tigraphy in differentiating between patients with epiphora and volunteers using a simple method. Methods: Twenty eyes in ten volunteers and 66 eyes in 55 pati...PURPOSE: To study the discriminatory ability of dacryoscin-tigraphy in differentiating between patients with epiphora and volunteers using a simple method. Methods: Twenty eyes in ten volunteers and 66 eyes in 55 patients with severe epiphora were studied. Dacryoscintigraphy (15 frames of 1min)was performed after administration of 4 MBq 99m Tc-pertechnetate (10 μl) in both eyes. By mapping a single region of interest (ROI)-over the conjunctival sac we determined T1 (%dose in first minute) and linear clearance rate (LCR, defined as 100%(T1-T15)/T1 from the tracer disappearance curve. Reproducibility was determined in volunteers. Conjunctival resorption was determined from completely obstructed systems. Sensitivity and specificity were calculated and receiver operating characteristics (ROC) analysis was conducted. Results: In volunteers mean T1 was 52.8±11.9%(95%CI 47.1-58.4%), and LCR was 74.2±11.1%(95%CI 69.0-79.4%). Reproducibility was good (mean difference 4.1±13.3%for T1 and 0.7±17%for LCR). Epiphora patients had clearly higher T1 (82.1±15.2%, P< 0.0001) and lower LCR (38.9±22.5%, P< 0.0001) values. Tracer resorption was 24%. Based on ROC analysis 70%for T1 and 50%for LCR were considered optimal cut-off levels to separate patients from volunteers. Sensitivity/specificity were 77/95%for T1 and 71/100%for LCR. T1 and LCR values did not correlate with symptomscores or Anel test results. Conclusion: Dacryoscintigraphy, using LCR and T1 as parameters, is a reliable and objectivemethod to detect tear-flow abnormalities.展开更多
Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the p...Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow-up study was to evaluate whether the effect on neurological condition persists until 18 mo. Methods: A prospective, double-blind, randomized control study was conducted. Three groups were formed: a control (CF:n = 169), an LC-PUFA-supplemented (LF:n = 146) and a breastfed (BF:n = 159) group. Information on potential confounders was collected at enrolment. At the age of 18 mo, neurodevelopmental condition was assessed by the age-specific neurological examination of Hempel and the Bayley scales. The Hempel assessment resulted in a clinical neurological diagnosis, a total optimality score and a score on the fluency of motility. The Bayley scales resulted in mental and psychomotor developmental indices. Attrition at 18 mo was 5.5%and non-selective. Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders. Results: None of the children had developed cerebral palsy and 23 (CF: n = 8; LF: n = 10; BF: n = 5) showed minor neurological dysfunction. The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices. Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition. Conclusion: This study indicates that the beneficial neurodevelopmental effect of 2 mo LC-PUFA supplementation in healthy term infants can not be detected at the age of 18 mo.展开更多
Objective: To study whether oral psoralen-UV-A (PUVA) with a portable tanning unit at home is as effective as hospital-administered bath PUVA in patients with chronic hand eczema. Design: Open-label randomized control...Objective: To study whether oral psoralen-UV-A (PUVA) with a portable tanning unit at home is as effective as hospital-administered bath PUVA in patients with chronic hand eczema. Design: Open-label randomized controlled trial, with a 10week treatment period and an 8-week follow-up period. Setting: Two university hospital dermatology departments in the Netherlands, specializinginhand eczema. Patients: One hundred fifty-eight patients with moderate to severe chronic hand eczema (more than 1 year induration). Interventions: Oral PUVA using methoxsalen capsules and a simple portable commercial facial tanning unit, or hospital-administered bath PUVA with trioxsalen. Main Outcome Measures: The primary outcome was clinical assessment by a hand eczema score (evaluation of desquamation, erythema, vesiculation, infiltration, fissures, itch, and pain, each on a 4-point scale) after 10 weeks of treatment. The secondary outcome was hand eczema score at 8 weeks of follow-up, after completion of treatment. The tertiary outcome was travel cost and time off work. Results: Both groups showed a comparable and substantial decrease in hand eczema score (meaningful clinical improvement). This decrease was maintained during the follow-up period. Patients treated with oral PUVA at home had lower travel costs and less time off work. Conclusions: Oral PUVA at home has a clinically relevant efficacy, similar to that of hospital-administered bath PUVA. This effect was maintained during an 8-week follow-up period. It resulted in lower travel costs and less time off work.展开更多
Background and Study Aims: In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal du...Background and Study Aims: In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal duodenum. To validate that practice we compared the diagnostic yield of endoscopic duodenal biopsies with that of endoscopic jejunal biopsies. In addition, we describe a method of or ienting biopsy specimens optimally. Patients and Methods: Upper endoscopy was performed with a colonoscope. Four jejunal and four duodenal biopsies were taken and oriented immediately thereafter. The pathologist rated the orientation as poor, adequate, or good, and histopathological results were expressed according to the Marsh classification. Jejunal and duodenal biopsy results were compared. Results: 146 patients were included. Jejunal biopsies were taken in 142 patients, and Marsh I-II lesions were found in 56 and Marsh III lesions in 15 patients. In three patients duodenal biopsies were normal while jejunal biopsies showed Marsh I-II lesions. No discrepancies were found in patients with Marsh III lesions. Orientation was good in all biopsies. Conclusion: Duodenal biopsies are sufficient to diagnose fullblown celiac disease (Marsh III), but Marsh I-II lesions may be missed in some cases.展开更多
Aims: An increased pulse pressure(PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure(CHF). In contrast, a decreased PP was re...Aims: An increased pulse pressure(PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure(CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. Methods and results: PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF(mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality[hazard ratio(HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure(MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP(HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP(HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide(ANP) and B-type natriuretic peptide(BNP). Conclusion: In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.展开更多
Progressive facial hemiatrophy (PFH) is a ubiquitous disease, characterized by hyperpigmentation of the skin followed by unilateral craniofacial atrophy of su bcutaneous tissues, including fat, muscle and bone. Heredi...Progressive facial hemiatrophy (PFH) is a ubiquitous disease, characterized by hyperpigmentation of the skin followed by unilateral craniofacial atrophy of su bcutaneous tissues, including fat, muscle and bone. Hereditary factors have been postulated to be involved in the aetiology of PFH. Yet, the occurrence of PFH i n one of two identicalmale twins reported heremakes this possibility unlikely. P FH usually occurs in the first two decades of life, and the clinical presentatio n resembles linear scleroderma. PFH may be complicated by autoimmune, neurologic al, ocular and dental disorders. Management of PFH comprises a long term follow -up of somatic disorders, and prevention of psychological problems. Treatment o f PFH is symptomatic and consists of plastic surgery after the disease activity has stopped. Conclusion: The occurrence of PFH in one of a monozygotic twin pair suggests that genetic factors are not involved in its aetiology. Early diagnosi s of PFH and accurate follow-up is essential to disclose the occurrence of comp lications.展开更多
Purpose: To evaluate various strategies designed to improve the specificity of the interpretation of results obtained with the frequency doubling technology p erimeter (FDT) used in the full-threshold mode. Methods: T...Purpose: To evaluate various strategies designed to improve the specificity of the interpretation of results obtained with the frequency doubling technology p erimeter (FDT) used in the full-threshold mode. Methods: Three different strate gies were compared using data from 452 glaucoma patients and 237 healthy subject s: combining several FDT parameters from a single test, combining the FDT test with a GDx test, and confirming an abnormal FDT test result with a repeat test. R esults: Confirming an abnormal FDT test result with a repeat test yielded a spec ificity increase of 0.10, from 0.80 to 0.90, at the expense of some loss of sens itivity for early but not for moderate or severe glaucoma. Combining several FDT parameters from a single test and combining FDT with GDx did not yield any noti ceable increase in diagnostic performance. Conclusions: A modest increase in FDT diagnostic performance can be obtained by the confirmation of an abnormal test result with a repeat test.展开更多
Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilat...Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.展开更多
文摘Purpose: To describe the baseline data of a large cohort of patients included for follow-up with perimetry using the frequency doubling technique (FDT) and w ith quantification of the retinal nerve fibre layer as assessed by GDx, and to c alculate the sensitivity and specificity of both devices from these baseline dat a. Methods: Regular visitors to our glaucoma service were included. All subjects were followed for at least 4 years with FDT in full-threshold mode, GDx and co nventional perimetry. Patients were classified as having either glaucoma or susp ect glaucoma, according to baseline perimetry results. In addition, a group of h ealthy subjects was recruited outside the hospital. Results: A total of 452 glau coma patients, 423 glaucoma suspects and 237 healthy subjects were incorporated into the analyses. Sensitivities for both FDT and GDx were fixed at 0.90. For th e group as a whole, the specificity was 0.81 for FDT, using number of depressed test-points p <0.01 in the total deviation probability plot with a cut-off poi nt >1, and 0.78 for GDx, using the Number, with a cut-off point >29. The area u nder the receiver operating characteristic (ROC)curve was 0.92 for FDT and 0.94 for GDx. Of the subjects with suspect glaucoma, 75%showed normal FDT test resul ts and 52%showed normal GDx results. Unlike FDT, GDx failed to detect some mode rate/severe glaucoma cases. Conclusions: The performances of FDT and GDx are app roximately equivalent in terms of sensitivity, specificity and area under the RO C curve. In glaucoma suspects, GDx in particular yielded a rather high percentag e of positive test results. The majority of these positive test results are pres umably false-positive results rather than results indicating preperimetric glau coma.
文摘Purpose: To develop an algorithm for the scoring of frequency doubling perimery (FDT) test results based on a statistical analysis of the distribution of the localisation of defects in glaucoma patients and normals, and to compare the performance of the new algorithm and all previously published algorithms in a glaucoma service based screening setting. Methods: The right eye
文摘Purpose: To clarify the discrepancy found in literature about a possible learning effect in frequency doubling perimetry (FDT) by measuring the learning effect in a large group of subjects of various ages, with and without perimetric experience, and with and without glaucoma Methods: Two FDT measurements were performed in three groups: young normals without perimeric experience (group I, n =26), aged normals without perimetric ex-
文摘Objectives This study aimed to investigate the prognostic importance of plasma erythropoietin(EPO) levels in chronic heart failure (CHF) patients. Background Anemia is common and is associated with an impaired survival in patients with CH F. Erythropoietin is a hematopoietic growth factor, upregulated in anemic condit ions. Little is known about the pathophysiology of anemia in CHF and the prognos tic importance of plasma EPO levels in CHF patients. Methods In 74 patients with CHF(age, 61±2 years; left ventricular ejection fraction,0.31±0.01; peak oxyge n consumption, 19.1±0.6 <<mean±SEM>>) and in 15 control patients, hemoglobin lev els and plasma concentrations of EPO and brain natriuretic peptide were measured . Results During a mean follow-up of 3.0 years (range, 2.3 to 5.3 years), 22 pa tients (30%) died. Anemia was present in 24%of the patients. Multivariate anal ysis showed that plasma EPO(p =0.026) and hemoglobin levels (p=0.005) were indep endent predictors of survival in this CHF population. We observed only a mild in verse correlation between the logarithm of EPO and hemoglobin levels (r2=0.08, p =0.02) in CHF patients,whereas the control group showed a clear significant inve rse correlation (r2=0.44, p=0.007). Conclusions Elevated plasma EPO levels are a ssociated with an impaired prognosis independent of hemoglobin levels and other established markers of CHF severity. Furthermore, in the CHF patients, EPO level s poorly correlate with the hemoglobin levels, in contrast with the control grou p.
文摘PURPOSE: To study the discriminatory ability of dacryoscin-tigraphy in differentiating between patients with epiphora and volunteers using a simple method. Methods: Twenty eyes in ten volunteers and 66 eyes in 55 patients with severe epiphora were studied. Dacryoscintigraphy (15 frames of 1min)was performed after administration of 4 MBq 99m Tc-pertechnetate (10 μl) in both eyes. By mapping a single region of interest (ROI)-over the conjunctival sac we determined T1 (%dose in first minute) and linear clearance rate (LCR, defined as 100%(T1-T15)/T1 from the tracer disappearance curve. Reproducibility was determined in volunteers. Conjunctival resorption was determined from completely obstructed systems. Sensitivity and specificity were calculated and receiver operating characteristics (ROC) analysis was conducted. Results: In volunteers mean T1 was 52.8±11.9%(95%CI 47.1-58.4%), and LCR was 74.2±11.1%(95%CI 69.0-79.4%). Reproducibility was good (mean difference 4.1±13.3%for T1 and 0.7±17%for LCR). Epiphora patients had clearly higher T1 (82.1±15.2%, P< 0.0001) and lower LCR (38.9±22.5%, P< 0.0001) values. Tracer resorption was 24%. Based on ROC analysis 70%for T1 and 50%for LCR were considered optimal cut-off levels to separate patients from volunteers. Sensitivity/specificity were 77/95%for T1 and 71/100%for LCR. T1 and LCR values did not correlate with symptomscores or Anel test results. Conclusion: Dacryoscintigraphy, using LCR and T1 as parameters, is a reliable and objectivemethod to detect tear-flow abnormalities.
文摘Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow-up study was to evaluate whether the effect on neurological condition persists until 18 mo. Methods: A prospective, double-blind, randomized control study was conducted. Three groups were formed: a control (CF:n = 169), an LC-PUFA-supplemented (LF:n = 146) and a breastfed (BF:n = 159) group. Information on potential confounders was collected at enrolment. At the age of 18 mo, neurodevelopmental condition was assessed by the age-specific neurological examination of Hempel and the Bayley scales. The Hempel assessment resulted in a clinical neurological diagnosis, a total optimality score and a score on the fluency of motility. The Bayley scales resulted in mental and psychomotor developmental indices. Attrition at 18 mo was 5.5%and non-selective. Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders. Results: None of the children had developed cerebral palsy and 23 (CF: n = 8; LF: n = 10; BF: n = 5) showed minor neurological dysfunction. The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices. Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition. Conclusion: This study indicates that the beneficial neurodevelopmental effect of 2 mo LC-PUFA supplementation in healthy term infants can not be detected at the age of 18 mo.
文摘Objective: To study whether oral psoralen-UV-A (PUVA) with a portable tanning unit at home is as effective as hospital-administered bath PUVA in patients with chronic hand eczema. Design: Open-label randomized controlled trial, with a 10week treatment period and an 8-week follow-up period. Setting: Two university hospital dermatology departments in the Netherlands, specializinginhand eczema. Patients: One hundred fifty-eight patients with moderate to severe chronic hand eczema (more than 1 year induration). Interventions: Oral PUVA using methoxsalen capsules and a simple portable commercial facial tanning unit, or hospital-administered bath PUVA with trioxsalen. Main Outcome Measures: The primary outcome was clinical assessment by a hand eczema score (evaluation of desquamation, erythema, vesiculation, infiltration, fissures, itch, and pain, each on a 4-point scale) after 10 weeks of treatment. The secondary outcome was hand eczema score at 8 weeks of follow-up, after completion of treatment. The tertiary outcome was travel cost and time off work. Results: Both groups showed a comparable and substantial decrease in hand eczema score (meaningful clinical improvement). This decrease was maintained during the follow-up period. Patients treated with oral PUVA at home had lower travel costs and less time off work. Conclusions: Oral PUVA at home has a clinically relevant efficacy, similar to that of hospital-administered bath PUVA. This effect was maintained during an 8-week follow-up period. It resulted in lower travel costs and less time off work.
文摘Background and Study Aims: In the past, small-bowel biopsies for diagnosis of celiac disease were taken from the jejunum with a suction capsule, but nowadays most physicians take endoscopic biopsies from the distal duodenum. To validate that practice we compared the diagnostic yield of endoscopic duodenal biopsies with that of endoscopic jejunal biopsies. In addition, we describe a method of or ienting biopsy specimens optimally. Patients and Methods: Upper endoscopy was performed with a colonoscope. Four jejunal and four duodenal biopsies were taken and oriented immediately thereafter. The pathologist rated the orientation as poor, adequate, or good, and histopathological results were expressed according to the Marsh classification. Jejunal and duodenal biopsy results were compared. Results: 146 patients were included. Jejunal biopsies were taken in 142 patients, and Marsh I-II lesions were found in 56 and Marsh III lesions in 15 patients. In three patients duodenal biopsies were normal while jejunal biopsies showed Marsh I-II lesions. No discrepancies were found in patients with Marsh III lesions. Orientation was good in all biopsies. Conclusion: Duodenal biopsies are sufficient to diagnose fullblown celiac disease (Marsh III), but Marsh I-II lesions may be missed in some cases.
文摘Aims: An increased pulse pressure(PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure(CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. Methods and results: PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF(mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality[hazard ratio(HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure(MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP(HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP(HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide(ANP) and B-type natriuretic peptide(BNP). Conclusion: In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.
文摘Progressive facial hemiatrophy (PFH) is a ubiquitous disease, characterized by hyperpigmentation of the skin followed by unilateral craniofacial atrophy of su bcutaneous tissues, including fat, muscle and bone. Hereditary factors have been postulated to be involved in the aetiology of PFH. Yet, the occurrence of PFH i n one of two identicalmale twins reported heremakes this possibility unlikely. P FH usually occurs in the first two decades of life, and the clinical presentatio n resembles linear scleroderma. PFH may be complicated by autoimmune, neurologic al, ocular and dental disorders. Management of PFH comprises a long term follow -up of somatic disorders, and prevention of psychological problems. Treatment o f PFH is symptomatic and consists of plastic surgery after the disease activity has stopped. Conclusion: The occurrence of PFH in one of a monozygotic twin pair suggests that genetic factors are not involved in its aetiology. Early diagnosi s of PFH and accurate follow-up is essential to disclose the occurrence of comp lications.
文摘Purpose: To evaluate various strategies designed to improve the specificity of the interpretation of results obtained with the frequency doubling technology p erimeter (FDT) used in the full-threshold mode. Methods: Three different strate gies were compared using data from 452 glaucoma patients and 237 healthy subject s: combining several FDT parameters from a single test, combining the FDT test with a GDx test, and confirming an abnormal FDT test result with a repeat test. R esults: Confirming an abnormal FDT test result with a repeat test yielded a spec ificity increase of 0.10, from 0.80 to 0.90, at the expense of some loss of sens itivity for early but not for moderate or severe glaucoma. Combining several FDT parameters from a single test and combining FDT with GDx did not yield any noti ceable increase in diagnostic performance. Conclusions: A modest increase in FDT diagnostic performance can be obtained by the confirmation of an abnormal test result with a repeat test.
文摘Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.
