The Experts below are selected from a list of 91164 Experts worldwide ranked by ideXlab platform
Béla Merkely - One of the best experts on this subject based on the ideXlab platform.
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Dual-chamber pacemaker implantation via both superior vena cavae in a Patient with persistent left superior vena cava
Heart Rhythm, 2010Co-Authors: Attila Roka, Béla MerkelyAbstract:Persistent left superior vena cava (SVC) is found in 0.3% to 0.7% of Patients during pacemaker implantation. The right SVC is patent in only 64% of these cases. 1 An atypical venous configuration may make pacemaker implantation difficult. Dual-chamber pacemaker implantation was planned in a 70year-old male Patient with Hypertension and third-degree AV block. Implantation of the right ventricular lead (Synox SX 60-BP passive fixation, Biotronik GmbH & Co., Berlin, Germany) was attempted from the left cephalic vein; however, the Patient was found to have persistent left SVC. Despite several attempts with each stylet included in the electrode kit, lead positioning via this route was impossible because stable ventricular position could not be achieved. The lead was finally passed through the intact right SVC without difficulty and placed on the right ventricular inferior wall. The right atrial lead (Synox SX 53-JBP passive fixation, Biotronik) was passed through the persistent left SVC and placed in a stable right atrial position on thefirst attempt. The pacemaker
Attila Roka - One of the best experts on this subject based on the ideXlab platform.
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Dual-chamber pacemaker implantation via both superior vena cavae in a Patient with persistent left superior vena cava
Heart Rhythm, 2010Co-Authors: Attila Roka, Béla MerkelyAbstract:Persistent left superior vena cava (SVC) is found in 0.3% to 0.7% of Patients during pacemaker implantation. The right SVC is patent in only 64% of these cases. 1 An atypical venous configuration may make pacemaker implantation difficult. Dual-chamber pacemaker implantation was planned in a 70year-old male Patient with Hypertension and third-degree AV block. Implantation of the right ventricular lead (Synox SX 60-BP passive fixation, Biotronik GmbH & Co., Berlin, Germany) was attempted from the left cephalic vein; however, the Patient was found to have persistent left SVC. Despite several attempts with each stylet included in the electrode kit, lead positioning via this route was impossible because stable ventricular position could not be achieved. The lead was finally passed through the intact right SVC without difficulty and placed on the right ventricular inferior wall. The right atrial lead (Synox SX 53-JBP passive fixation, Biotronik) was passed through the persistent left SVC and placed in a stable right atrial position on thefirst attempt. The pacemaker
Mark G Davies - One of the best experts on this subject based on the ideXlab platform.
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divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis
Journal of Vascular Surgery, 2004Co-Authors: Nayan Sivamurthy, Scott M Surowiec, Eva Culakova, Jeffrey M Rhodes, Yaron Sternbach, David L Waldman, Richard M Green, Mark G DaviesAbstract:Abstract Objective Percutaneous intervention for symptomatic renal artery atherosclerosis is rapidly replacing surgery in many centers. This study evaluated the anatomic and functional outcomes of endovascular therapy for atherosclerotic renal artery stenosis on a combined vascular surgery and interventional radiology service at an academic medical center. Methods This was a retrospective analysis of Patients who underwent renal artery angioplasty with or without stenting between January 1990 and June 2002. Indications included Hypertension (86%) and rising serum creatinine concentration (55%). One hundred forty-six Patients (80 women; average age, 71 years [range, 44-89 years]) underwent 183 attempted interventions (64 to treat bilateral stenosis). Forty-five percent of Patients had significant bilateral disease: 27% had greater than 50% bilateral stenosis, and the remainder had nonfunctioning, absent, or occluded vessels. Results Of 183 planned interventions, technical success ( Conclusions Endovascular intervention for symptomatic atherosclerotic renal artery stenosis is technically successful. There were excellent patency and low recurrent stenosis rates. There is immediate clinical benefit for most Patients, but divergent long-term functional outcomes. Endovascular interventions modestly enhance the care of the Patient with Hypertension, but poorly preserve long-term renal function in the Patient with chronic renal impairment.
Nayan Sivamurthy - One of the best experts on this subject based on the ideXlab platform.
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divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis
Journal of Vascular Surgery, 2004Co-Authors: Nayan Sivamurthy, Scott M Surowiec, Eva Culakova, Jeffrey M Rhodes, Yaron Sternbach, David L Waldman, Richard M Green, Mark G DaviesAbstract:Abstract Objective Percutaneous intervention for symptomatic renal artery atherosclerosis is rapidly replacing surgery in many centers. This study evaluated the anatomic and functional outcomes of endovascular therapy for atherosclerotic renal artery stenosis on a combined vascular surgery and interventional radiology service at an academic medical center. Methods This was a retrospective analysis of Patients who underwent renal artery angioplasty with or without stenting between January 1990 and June 2002. Indications included Hypertension (86%) and rising serum creatinine concentration (55%). One hundred forty-six Patients (80 women; average age, 71 years [range, 44-89 years]) underwent 183 attempted interventions (64 to treat bilateral stenosis). Forty-five percent of Patients had significant bilateral disease: 27% had greater than 50% bilateral stenosis, and the remainder had nonfunctioning, absent, or occluded vessels. Results Of 183 planned interventions, technical success ( Conclusions Endovascular intervention for symptomatic atherosclerotic renal artery stenosis is technically successful. There were excellent patency and low recurrent stenosis rates. There is immediate clinical benefit for most Patients, but divergent long-term functional outcomes. Endovascular interventions modestly enhance the care of the Patient with Hypertension, but poorly preserve long-term renal function in the Patient with chronic renal impairment.
Gordon H. Williams - One of the best experts on this subject based on the ideXlab platform.
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Quality of Life as a Therapeutic End-Point
Drug Safety, 1991Co-Authors: Norman K. Hollenberg, Marcia Testa, Gordon H. WilliamsAbstract:The term ‘quality of life’ is finding increasing use in the popular press and the medical community. In both areas, its use often lacks precision: a comprehensive and universal definition probably does not exist. Indeed, the precise elements contributing probably vary from person to person and from time to time. There is broad agreement that 5 major areas always need assessment, including physical and emotional state, performance of social roles, intellectual function and general feelings of well-being or life satisfaction. A wide range of instruments has been employed in a large number of studies on the effects of antihypertensive agents on quality of life in the Patient with Hypertension. Hypertension represents a special problem in which the Patient is thought to be free of related symptoms, and treatment designed to improve natural history brings with it the burden of adverse reactions. Although some insights have been gained on the relative influence of various therapeutic regimens on the quality of life of treated Patients, in many of the studies too little consideration has been given to the use of instruments that have been validated in the Patient population to be studied, to the power of the study and its design, to the contribution of confounding variables such as age and gender, and to evidence that short term trials (measured in weeks) can miss important changes that occur over months in a process where treatment is life-long. For these reasons, we believe, the literature on the subject is burdened by many reports that describe no difference among treatment regimens where important differences might exist. On the positive side, important advances have been made in our understanding of the elements that contribute to quality of life and in approaches to its assessment.