RESUMEN
Successful transfer of evidence based prevention programs and interventions in health care is a precondition for improvement of public health. The BMBF research focus on prevention contained substantial transfer experiences that have been analysed. As a result, a set up of a new research focus including specific methodology was recommended. The paper summarizes the KNP transfer results.
Asunto(s)
Atención a la Salud/organización & administración , Medicina Basada en la Evidencia/organización & administración , Modelos Organizacionales , Servicios Preventivos de Salud/organización & administración , Prevención Primaria/organización & administración , Mejoramiento de la Calidad/organización & administración , AlemaniaRESUMEN
From 2004 to 2013, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. Objectives of this programme were the prevention of widespread health risks and diseases and to reinforce health promotion. Within this programme, 4 phases concentrated on socially disadvantaged target groups and on methodical and structural challenges relating to prevention/ health promotion. The projects covered evaluating the effectiveness of existing or newly-designed measures, developing and testing new concepts, programmes and access routes. Furthermore, the projects should contribute to the development of methods. The umbrella project "Kooperation für nachhaltige Präventionsforschung" (KNP-Cooperation for sustainable prevention research) was set up in 2009 to support the meaningful processing and application of key knowledge from this BMBF funding focus on prevention research and to promote networking between science, practice, and politics.
Asunto(s)
Redes Comunitarias/organización & administración , Predicción , Programas de Gobierno/organización & administración , Promoción de la Salud/organización & administración , Investigación sobre Servicios de Salud/tendencias , Medicina Preventiva/organización & administración , Alemania , Agencias Gubernamentales/organización & administración , Mejoramiento de la Calidad/organización & administraciónRESUMEN
Crystalline retinopathy is a rare complication of chronic retinal detachment. The observation of crystalline retinal deposits should prompt the search for a chronic retinal detachment. The composition of these crystals is unknown. Some other crystals can be found in other diseases or with drug toxicity. It is essential to make the differential diagnosis and to determine the actual etiology
Asunto(s)
Cristalino/patología , Desprendimiento de Retina/diagnóstico , Enfermedades de la Retina/diagnóstico , Adulto , Enfermedad Crónica , Femenino , Humanos , Desprendimiento de Retina/complicaciones , Enfermedades de la Retina/complicacionesRESUMEN
Systemic lupus erythematosus (SLE) is an autoimmune disease that can significantly impact both physiological and psychological functioning. In order to examine the relationship between psychological functioning and disease activity in SLE, we administered instruments that collected sociodemographic information and measured indices of disease activity and psychosocial functioning from 125 adult Hispanic and White patients with SLE. Patients were recruited from four healthcare settings in the greater Southern California area. Both cross-sectional and longitudinal relationships between depression and disease activity were evaluated. Cross-sectional findings revealed that depression and ethnicity were independently correlated with self-reported disease activity. Longitudinally, depression alone predicted self-reported disease activity. These data suggest that depression may play a significant role in the health status of SLE patients and serve as an important target for clinical intervention.
Asunto(s)
Trastorno Depresivo/psicología , Lupus Eritematoso Sistémico/fisiopatología , Lupus Eritematoso Sistémico/psicología , Índice de Severidad de la Enfermedad , Adulto , California , Estudios Transversales , Etnicidad/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , AutoimagenRESUMEN
Cardiac tamponade can manifest as profound hypoxemia from intracardiac shunting across a patent foramen ovale. As a consequence, pulmonary embolus can be erroneously diagnosed. As demonstrated in the case described herein, transesophageal echocardiography can be useful in determining the correct diagnosis, especially if transthoracic echocardiography is technically limited. In our patient, the findings on transesophageal echocardiography also helped determine the appropriate treatment. The relative inaccessibility of the pericardial effusion to needle drainage prompted open surgical drainage.
Asunto(s)
Taponamiento Cardíaco/complicaciones , Ecocardiografía/métodos , Defectos del Tabique Interatrial/fisiopatología , Anciano , Taponamiento Cardíaco/fisiopatología , Diagnóstico Diferencial , Drenaje , Esófago , Femenino , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Hipoxia/etiología , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Embolia Pulmonar/diagnósticoRESUMEN
We observed the combination of the Robin sequence with perodactyly (hypoplasia and/or agenesis of the distal phalanx of the toes) and cardiac arrhythmia (ventricular extrasystoles occurring as bigemini or multifocal tachycardia with syncopal episodes) in 6 relatives in 3 generations. This familial association has not been reported before and probably represents a previously unrecognized heritable malformation syndrome.
Asunto(s)
Anomalías Múltiples/genética , Complejos Cardíacos Prematuros/genética , Deformidades Congénitas de las Extremidades , Síndrome de Pierre Robin/genética , Adolescente , Adulto , Niño , Femenino , Genes Dominantes , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Linaje , SíndromeRESUMEN
Our experience with pulmonary valve insertion during reoperation for residual lesions after initial open repair of tetralogy of Fallot in 15 patients is reported. Preoperatively, 14 patients were in moderate to severe congestive heart failure, and all 15 had decreased right ventricular (RV) function at cardiac catheterization. All 15 patients had pulmonary insufficiency but not as an isolated finding. The most common residual lesions encountered were ventricular septal defect in 9, tricuspid insufficiency in 11, and peripheral pulmonary arterial stenosis in 6. Tissue valves were inserted in all patients. Mean peak RV-left ventricular pressure ratio measured in the operating room decreased from 0.61 +/- 0.10 (+/- the standard deviation) to 0.47 +/- 0.17 (p less than 0.05). There were no operative deaths. At follow-up (mean, 33 months), all but 1 patient were in New York Heart Association Class I or II. Pulmonary valve insertion should be considered during reoperation for tetralogy of Fallot when pulmonary insufficiency and RV failure are present.
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Válvula Pulmonar/trasplante , Tetralogía de Fallot/cirugía , Adulto , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Insuficiencia de la Válvula Pulmonar/cirugía , Reoperación , Factores de TiempoRESUMEN
Thoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and left hemidiaphragm, with autotransplantation of splenic tissue into the left hemithorax. It is usually an incidental finding on chest plain film or computed tomogram and is rarely diagnosed without biopsy or operation. A history of old splenic trauma and findings of left-sided, pleural-based nodules should indicate the diagnosis, which can be confirmed with nuclear medicine studies.
Asunto(s)
Esplenosis/diagnóstico , Tórax , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Cintigrafía , Bazo/lesiones , Esplenosis/diagnóstico por imagen , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A patient with an unusual left ventricular outflow tract obstruction caused by a solitary pedunculated left ventricular rhabdomyoma is described. Diagnosis was based on two-dimensional echocardiographic findings alone. The obstructive portion of the tumor was successfully removed from the interventricular septum by an aortic root approach.
Asunto(s)
Neoplasias Cardíacas/diagnóstico , Rabdomioma/diagnóstico , Ultrasonografía , Femenino , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Tabiques Cardíacos , Humanos , Recién Nacido , Rabdomioma/patología , Rabdomioma/cirugíaRESUMEN
This study measured endothelial permeability, quantitatively (with iodine 125-labeled albumin) and qualitatively (with Evans blue dye) in arterialized vein grafts in 9 adult dogs. In each dog, the right common carotid artery was ligated and arterial flow was reconstituted with a 5-cm bypass graft of right external jugular vein. Twenty-four hours before the dogs were killed, each dog received both 125I-labeled albumin (8 microCi/kg) and Evans blue dye (15 mg/kg) intravenously. After the dogs' death, each arterialized vein graft and each left external jugular vein (as control) was harvested and studied. Arterialized vein graft permeability was significantly increased over control at 1, 3, and 6 months (3 dogs at each interval). Scanning electron microscopy revealed confluent endothelium in all specimens. This increased permeability may play a role in vein graft atherosclerosis.
Asunto(s)
Albúminas/farmacocinética , Compuestos Azo/farmacocinética , Endotelio Vascular/metabolismo , Azul de Evans/farmacocinética , Animales , Perros , Endotelio Vascular/ultraestructura , Radioisótopos de Yodo , PermeabilidadRESUMEN
We report a tricuspid valve papillary fibroelastoma initially detected by transthoracic two-dimensional echocardiography and subsequently characterized by transesophageal two-dimensional echocardiography. The mass was excised during open heart operation, and the diagnosis was verified grossly and histopathologically. Transesophageal echocardiography usually provides images far superior to those from transthoracic echocardiography and may be a useful adjunct for intraoperative localization of intracardiac tumors for excision.
Asunto(s)
Ecocardiografía , Fibroma/diagnóstico por imagen , Músculos Papilares , Válvula Tricúspide , Anciano , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/cirugía , Femenino , Fibroma/cirugía , HumanosRESUMEN
Chronic lymphocytic leukemia is a disease of the elderly. It tends to have a variable clinical course. Because of the patients' immunologically dysfunctional state, there has been reluctance to perform open cardiac procedures because of concern about early postoperative sepsis leading to death. To assess the risk of coronary artery bypass grafting in elderly patients, the records of 26 patients (mean age, 69.6 +/- 4.9 years) with chronic lymphocytic leukemia who underwent coronary artery bypass grafting between January 1975 and July 1990 were retrospectively reviewed. Nineteen underwent isolated coronary artery bypass grafting, and 7 had combined procedures. The operative mortality rate was 7.7%. Postoperative infections developed in 6 patients (23.1%): pneumonia in 3 and sternal osteomyelitis, acute parotiditis, and bacteremia in 1 each. One of these 6 patients died of acute Serratia pneumonitis. Twenty-four patients (92.3%) were discharged from the hospital an average of 10.6 +/- 7.7 days postoperatively. Patients with chronic lymphocytic leukemia can undergo coronary artery bypass grafting with acceptable mortality but with increased risk of postoperative infection.
Asunto(s)
Puente de Arteria Coronaria , Leucemia Linfocítica Crónica de Células B , Anciano , Infecciones Bacterianas/etiología , Femenino , Estudios de Seguimiento , Hemoglobinas/análisis , Humanos , Tiempo de Internación , Leucemia Linfocítica Crónica de Células B/sangre , Leucemia Linfocítica Crónica de Células B/patología , Recuento de Leucocitos , Linfocitos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neutrófilos/patología , Recuento de Plaquetas , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , gammaglobulinas/análisisRESUMEN
Echocardiographic characterization of cardiac masses involving the left atrium are defined by morphologic shape and appearance, site of attachment, type of margins, and presence or absence in the left atrial appendage. Most reports use location in the LAA as strong supportive evidence of thrombus, especially if associated with other suggestive findings (i.e., atrial fibrillation, spontaneous echo contrast, or both). Other reported masses (non-thrombi) in the left atrial appendage are considered extremely rare. We report a case of a patient with coexisting aortic stenosis and atrial fibrillation diagnosed intraoperatively by transesophageal echocardiography with myxoma of the left atrial appendage.
Asunto(s)
Insuficiencia de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/complicaciones , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Anciano , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Atrios Cardíacos , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/patología , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Periodo Intraoperatorio , Masculino , Mixoma/complicaciones , Mixoma/patologíaRESUMEN
BACKGROUND AND AIMS OF THE STUDY: No prior studies have defined pre- versus postoperative hemodynamics of large numbers of patients with low mean transvalvular gradients. This was our objective. METHODS: Retrospective analysis was undertaken of preoperative and postoperative echo/Doppler data in 294 patients who underwent aortic valve replacement (AVR) for aortic stenosis (AS). Some 136 patients had a preoperative mean gradient of < 50 mmHg. The relationship of preoperative to pre- minus postoperative (delta) mean gradient (GRAD), peak valvular velocity (V2), left ventricular outflow tract velocity (V1), V1/V2 ratio, V2-V1, and aortic valve area (AVA) were plotted and analyzed such that a 'zero-benefit threshold' from surgery could be estimated. RESULTS: Strong relationships (r > 0.80) were noted for GRAD to delta GRAD, V2 to delta V2, and (V2-V1) to delta (V2-V1) with zero-benefit thresholds of 16 mmHg for GRAD, 2.6 m/s for V2 and 1.7 m/s for V2-V1. These thresholds were lower in patients who received homografts (11 mmHg, 2.2 m/s, and 1.1 m/s respectively), p < 0.02. The relationship of pre operative V1/V2 to delta V1/V2 and AVA-delta AVA were weaker (r = 0.52 and 0.33 respectively) with zero-benefit thresholds of 0.41 and 2.0 cm2. Among patients with depressed preoperative fractional shortening, improvement was confined to those without coexistent coronary artery disease. CONCLUSION: This analysis of thresholds of mean gradient benefit suggests that most patients with low gradient AS improve hemodynamically from AVR. The hemodynamic 'break-even' point averages a mean gradient of 16 mmHg.
Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/trasplante , Prótesis Valvulares Cardíacas , Hemodinámica , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Bioprótesis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Homólogo , Resultado del Tratamiento , UltrasonografíaRESUMEN
Bronchial atresia is a rare anomaly that characteristically presents with a pulmonary nodule and hyperinflation of the lung distal to the nodule. To make this diagnosis definitively, invasive studies have been required. Now with the combined use of computed tomography and magnetic resonance imaging, a diagnosis can be made without resorting to invasive techniques. This article describes a case of bronchial atresia illustrating the noninvasive approach.
Asunto(s)
Bronquios/anomalías , Broncografía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adulto , Bronquios/patología , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , MasculinoRESUMEN
Ectodermal dysplasia with arthrogryposis is an uncommon condition. We describe two daughters of a distant consanguineous couple with oligodentia, enamel abnormalities, camptodactyly, longitudinally broken nails, growth retardation, joint contractures with amyotrophy, hypohidrotic skin with tendency to excessive bruising and scarring after injuries and scratching, kypho-scoliosis, mild facial dysmorphia and microcephaly. The condition is probably due to an autosomal recessive gene, the parents being gypsies of the same ancestral origin.
Asunto(s)
Artrogriposis/genética , Aberraciones Cromosómicas/genética , Displasia Ectodérmica/genética , Genes Recesivos/genética , Adulto , Artrogriposis/diagnóstico , Niño , Trastornos de los Cromosomas , Consanguinidad , Displasia Ectodérmica/diagnóstico , Femenino , Homocigoto , Humanos , Arcada Parcialmente Edéntula/genética , Linaje , FenotipoRESUMEN
A girl with pancytopenia (hemoglobin 9 g. 2,000 PMN. 75,000 platelets) was examined at 23 years of age. She had microcephaly, facial dysmorphy, skeletal deformities (kypho-scoliosis, club feet, club hands) and mental retardation. Puberty was normal, Roentgenograms showed bilateral agenesia of the distal part of the ulna with dislocation of the head of the radius. No other skeletal parts were absent. The condition is probably due to an autosomal recessive gene, the parents being second cousins.
Asunto(s)
Aberraciones Cromosómicas/genética , Huesos Faciales/anomalías , Genes Recesivos/genética , Discapacidad Intelectual/genética , Trombocitopenia/genética , Cúbito/anomalías , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/genética , Adulto , Aberraciones Cromosómicas/diagnóstico , Trastornos de los Cromosomas , Pie Equinovaro/diagnóstico , Pie Equinovaro/genética , Consanguinidad , Femenino , Humanos , Discapacidad Intelectual/diagnóstico , Escoliosis/diagnóstico , Escoliosis/genética , Síndrome , Trombocitopenia/diagnósticoRESUMEN
A boy with MCA/MR and a fragile site (FS) at 8q22 opens the discussion of a possible association between a rare autosomal FS and an abnormal phenotype. The child was born after prenatal diagnosis of ureterohydronephrosis. He had facial dysmorphia and mental retardation (IQ = 40). The karyotype showed 8q22 FS in 12% of the cells obtained after addition of FUdR to the culture medium. No other etiologic factor was shown to be responsible for the MCA/MR syndrome. Several authors have reported a variety of neurodevelopmental abnormalities and mental retardation in individuals with rare FS expressed on chromosomes 2, 9, 10, 16 and 19. If rare FS predispose to phenotypic abnormalities what are the mechanisms?
Asunto(s)
Aberraciones Cromosómicas/genética , Fragilidad Cromosómica , Anomalías Congénitas/genética , Enfermedades Fetales/genética , Discapacidad Intelectual/psicología , Aberraciones Cromosómicas/patología , Trastornos de los Cromosomas , Sitios Frágiles del Cromosoma , Anomalías Congénitas/patología , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido , Discapacidad Intelectual/genética , Discapacidad Intelectual/patología , Cariotipificación , Perinatología , Fenotipo , EmbarazoRESUMEN
BACKGROUND: Abnormal thyroid function was shown in children with Down syndrome (DS). This study was undertaken in order to specify these anomalies. POPULATION AND METHODS: Thyroid function of 105 children with DS aged from 3 months to 20 years was studied by evaluation of serum concentration of thyrotropin, free T4 (FT4), free T3 (FT3) and reverse T3 (rT3). Each DS child was matched to a control of the same age. RESULTS: The mean concentration of thyrotropin of children with DS was increased while the mean concentration of rT3 of the DS children was significantly decreased compared with the controls, as was the ratio rT3/TSH. When DS children are split into two groups, those with and those without increased thyrotropinemia, a significant decrease in the ratio rT3/TSH appeared in DS children with increased thyrotropinemia whereas there is no difference between these two groups regarding to level of FT4, FT3, rT3 and zincemia. However, in all DS children serum zinc levels were lower than in controls. Thyrotropin levels rapidly normalized after thyroxin treatment. CONCLUSION: One half of the children with DS have increased thyrotropinemia and all have a decreased rT3.