Some of the factors that affect the development of internal complications in diabetes mellitus may play a role in the development of diabetic dermopathy, and diabetic dermopathy may serve as a clinical sign of an increased likelihood of these internal complications in diabetic patients.
Objective
To demonstrate the clinical feasibility of accurately measuring tricuspid annular area by 3-dimensional (3D) transesophageal echocardiography (TEE) and to assess the geometric differences based on the presence of tricuspid regurgitation (TR). Also, the shape of the tricuspid annulus was compared with previous descriptions in the literature.
Design
Prospective.
Setting
Tertiary care university hospital.
Interventions
Three-dimensional TEE.
Participants
Patients undergoing cardiac surgery.
Measurements and Main Results
Volumetric data sets from 20 patients were acquired by 3D TEE and prospectively analyzed. Comparisons in annular geometry were made between groups based on the presence of TR. The QLab (Philips Medical Systems, Andover, MA) software package was used to calculate tricuspid annular area by both linear elliptical dimensions and planimetry. Further analyses were performed in the 4D Cardio-View (TomTec Corporation GmBH, Munich, Germany) and MATLAB (Natick, MA) software environments to accurately assess annular shape. It was found that patients with greater TR had an eccentrically dilated annulus with a larger annular area. Also, the area as measured by the linear ellipse method was overestimated as compared to the planimetry method. Furthermore, the irregular saddle-shaped geometry of the tricuspid annulus was confirmed through the mathematic model developed by the authors.
Conclusions
Three-dimensional TEE can be used to measure the tricuspid annular area in a clinically feasible fashion, with an eccentric dilation seen in patients with TR. The tricuspid annulus shape is complex, with annular high and low points, and annular area calculation based on linear measurements significantly overestimates 3D planimetered area.
In this integrated ST elevation myocardial infarction network survival and neurological outcome of selected patients with ROSC after OHCA and treated with PCI was good. There is insufficient evidence about the outcome of this approach, which has a significant impact on utilisation of resources. Good quality randomised controlled trials are needed. In selected patients successfully resuscitated after OHCA of presumed cardiac aetiology, we believe that a more liberal application of primary PCI may be considered in experienced acute cardiac referral centres.
Background:Over the past decade, prehospital and in-hospital treatment for
out-of-hospital cardiac arrest (OHCA) has improved considerably. There are
sparse data on the long-term outcome, especially in elderly patients. We
studied whether elderly patients benefit to the same extent compared with
younger patients and at long-term follow up as compared with the general
population.Methods:Between 2001 and 2010, data from all patients presented to our hospital after
OHCA were recorded. Elderly patients (⩾75 years) were compared with younger
patients. Neurological outcome was classified as cerebral performance
category (CPC) at hospital discharge and long-term survival was compared
with younger patients and predicted survival rates of the general
population.Results:Of the 810 patients admitted after OHCA, a total of 551 patients (68%)
achieved return of spontaneous circulation, including 125 (23%) elderly
patients with a mean age of 81 ± 5 years. In-hospital survival was lower in
elderly patients compared with younger patients with rates of 33%
versus 57% (p < 0.001). A CPC of 1
was present in 73% of the elderly patients versus 86% of
the younger patients (p = 0.031). In 7.3% of the elderly
patients, a CPC >2 was observed versus 2.5% of their
younger counterparts (p = 0.103). Elderly patients had a
median survival of 6.5 [95% confidence interval (CI) 2.0–7.9] years compared
with 7.7 (95% CI 7.5–7.9) years of the general population
(p = 0.019).Conclusions:The survival rate after OHCA in elderly patients is approximately half that
of younger patients. Elderly patients who survive to discharge frequently
have favorable neurological outcomes and a long-term survival that
approximates that of the general population.
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