35 research outputs found
Prenatal diagnosis in Treacher Collins syndrome using combined linkage analysis and ultrasound imaging.
Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy
Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms
Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-12
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery Guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 3% and the patient's life expectancy is 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized. (Cite this article as: Paraskevas KI, Mikhailidis DP, Baradaran H, Davies AH, Eckstein HH, Faggioli G, et al. Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-12. Int Angiol 2021;40:487-96. DOI: 10.23736/S03929590.21.04751-9
Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-12
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized
The Treatment of Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder
routinely encountered by healthcare providers. Although not life-threatening,
this chronic disorder reduces patients’ quality of life and imposes a
significant economic burden to the healthcare system. IBS is no longer
considered a diagnosis of exclusion that can only be made after performing a
battery of expensive diagnostic tests. Rather, IBS should be confidently
diagnosed in the clinic at the time of the first visit using the Rome III
criteria and a careful history and physical examination. Treatment options for
IBS have increased in number in the past decade and clinicians should not be
limited to using only fiber supplements and smooth muscle relaxants. Although
all patients with IBS have symptoms of abdominal pain and disordered defecation,
treatment needs to be individualized and should focus on the predominant
symptom. This paper will review therapeutic options for the treatment of IBS
using a tailored approach based on the predominant symptom. Abdominal pain,
bloating, constipation and diarrhea are the four main symptoms that can be
addressed using a combination of dietary interventions and medications.
Treatment options include probiotics, antibiotics, tricyclic antidepressants,
selective serotonin reuptake inhibitors and agents that modulate chloride
channels and serotonin. Each class of agent will be reviewed using the latest
data from the literature