Abstract:
OBJECTIVE:To determine how often patients with renal artery stenosis (RAS) managed without revascularization progress to accelerated hypertension and/or renal failure. PATIENTS AND METHODS:We examined the outcomes of 68 patients (mean +/- SEM age, 71.8 +/- 0.9 years) with high-grade (>70%) RAS identified between 1989 and 1993 who were treated without renal revascularization for at least 6 months after angiography. The time to last follow-up averaged 38.9 +/- 2.8 months. Other vascular beds were affected in 66 of the 68 patients. End points were revascularization, nephrectomy, dialysis, or death. RESULTS:The mean +/- SEM serum creatinine level rose from 1.4 +/- 0.1 to 2.0 +/- 0.2 mg/dL (P<.001). Mean +/- SEM blood pressure did not change (157 +/- 3/83+/-2 vs 155 +/- 3/79 +/- 2 mm Hg), but the need (mean +/- SEM) for medication increased from 1.6+/-0.1 to 1.9+/-0.1 drugs (P=.02). Four patients (5.8%) eventually underwent renal revascularization for refractory hypertension (1 patient), for progressive stenosis (1 patient), and during aortic reconstruction (2 patients). One additional patient underwent nephrectomy to improve blood pressure control. Five others (7.4%) developed end-stage renal disease (ESRD) for reasons other than progressive vascular disease, namely, diabetes (3 patients), atheroemboli (1 patient), and contrast toxicity without RAS progression (1 patient). In 1 further case, the reason for ESRD was unknown, and it may have been caused by vascular occlusion. During follow-up, 19 patients died of unrelated causes, including myocardial infarction and stroke. CONCLUSIONS:These data indicate that antihypertensive medication requirements increased and renal function deteriorated modestly in a subset of patients with atherosclerotic RAS managed initially without vascular intervention. Many achieved stable blood pressure for many years. Deterioration of renal function and mortality risk were greatest in patients with bilateral stenosis or stenosis to a solitary functioning kidney. These results reinforce the need for meticulous follow-up for disease progression but underscore the role of competing risks and high mortality from other cardiovascular diseases, which primarily determine the outcomes in patients with RAS and widespread atherosclerotic disease.
journal_name
Mayo Clin Procjournal_title
Mayo Clinic proceedingsauthors
Chábová V,Schirger A,Stanson AW,McKusick MA,Textor SCdoi
10.4065/75.5.437keywords:
subject
Has Abstractpub_date
2000-05-01 00:00:00pages
437-44issue
5eissn
0025-6196issn
1942-5546pii
S0025-6196(11)64210-9journal_volume
75pub_type
杂志文章abstract::In the last 20 years, the treatment of mood disorders has advanced immeasurably. We now have relatively safe and effective agents for the treatment of depression and mania. This review discusses two types of agents that elevate mood--tricyclic antidepressants and monoamine oxidase inhibitors--including the indications...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:
更新日期:1979-05-01 00:00:00
abstract::The first 100 liver transplantations at the Mayo Clinic were performed in 83 patients, who required a total of 917 patient days in the intensive-care unit (ICU). The mean duration of stay in the ICU was 5.91 days after liver transplantation and 6.15 days for patients who subsequently required readmission to the ICU. D...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65734-6
更新日期:1989-04-01 00:00:00
abstract::Coronary artery fistulas are infrequently encountered vascular communications that are either congenital or due to cardiac trauma. Most patients with these anomalies are asymptomatic, but late complications can occur and include congestive heart failure, myocardial ischemia, arrhythmias, and endocarditis. Therefore, m...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/71.1.37
更新日期:1996-01-01 00:00:00
abstract::Risk stratification and risk-benefit ratios are extremely important in guiding patient-physician interactions as well as patient and family counseling. Risks associated with percutaneous transluminal coronary angioplasty are (1) compromise of the vessel lumen or vessel integrity, (2) unsuccessful procedure, and (3) re...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/78.12.1507
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To study the impact of parental leave on extending residency training and the timing of entrance into the specialty board certification examination system. METHODS:From June 3, 2005, through December 28, 2005, primary specialty board policies regarding parental leave, absence from training, and the timing of...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/81.11.1449
更新日期:2006-11-01 00:00:00
abstract::Clopidogrel bisulfate, a widely used inhibitor of platelet aggregation, is considered at least as safe as aspirin. We describe a patient who developed a systemic inflammatory response syndrome consisting of high fever, tachycardia, cellulitis-like rash, impaired liver function, and mild leukopenia after receiving clop...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/78.5.618
更新日期:2003-05-01 00:00:00
abstract::It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases. However, there remains cynicism about the lack of randomized controlled trials to support the association studies regarding the nonskele...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2013.05.011
更新日期:2013-07-01 00:00:00
abstract::A 71-year-old man had painful blue toes after an episode of protracted vomiting. Abdominal, cardiac, and transesophageal ultrasound studies were performed before angiography was considered. A large mobile mass in the proximal descending thoracic aorta, which suggested thrombus, was identified by transesophageal echoca...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60048-2
更新日期:1993-03-01 00:00:00
abstract::Campylobacter-like organisms (provisionally named C. pyloridis) were demonstrated in gastric biopsy specimens by histopathologic analysis and bacterial culture. C. pyloridis organisms were found in 12 of 26 patients (46%) with gastric or duodenal ulcer but in none of 10 healthy volunteers without histologic evidence o...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)61902-8
更新日期:1987-04-01 00:00:00
abstract::Anesthesia support for patients undergoing orthotopic liver transplantation can be complicated because of multiple medical problems in such patients and rapid hemodynamic, metabolic, and coagulation changes intraoperatively. Preoperative assessment should include careful review of the cardiovascular, respiratory, and ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65677-8
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To analyze the influence of recent changes in Minnesota statutes that generally require prior authorization for use of medical records for research from patients who received medical care after Jan. 1, 1997. MATERIAL AND METHODS:In this Mayo Clinic Institutional Review Board-approved study, we obtained a str...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/74.4.330
更新日期:1999-04-01 00:00:00
abstract::A decrease in blood androgen levels is well documented in women who experience natural or surgical menopause. This change may be associated with various negative effects on bone metabolism in addition to psychosocial and sexuality aspects of life. A review of published information on androgen replacement therapy shows...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/72.11.1051
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the association between coffee consumption and mortality from all causes and from cardiovascular disease. PATIENTS AND METHODS:Data from the Aerobics Center Longitudinal Study representing 43,727 participants with 699,632 person-years of follow-up were included. Baseline data were collected by an...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2013.06.020
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVES:To describe cerebrospinal fluid (CSF) findings in patients with posterior reversible encephalopathy syndrome (PRES) and to study its association with vasogenic edema. PATIENTS AND METHODS:Retrospective review of 73 consecutive prospectively collected adults diagnosed with PRES from January 1, 2000, through ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2015.07.018
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:In essential tremor and Parkinson disease (PD) tremor, administration of onabotulinumtoxinA via a fixed injection approach improves the tremor, but many patients (30%-70%) develop moderate to severe hand weakness, limiting the use of onabotulinumtoxinA in clinical practice. OBJECTIVE:To evaluate the safety ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.mayocp.2017.06.010
更新日期:2017-09-01 00:00:00
abstract::As alternatives to transurethral resection of the prostate for treatment of benign prostatic hyperplasia, various types of laser prostatectomy-most notably, neodymium:yttrium-aluminum-garnet (YAG) and potassium titanyl phosphate laser procedures-have proved to be associated with considerably less morbidity (for exampl...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.4065/73.8.792
更新日期:1998-08-01 00:00:00
abstract::Stereotactic ventralis lateralis thalamotomy can be performed in selected patients with medically intractable parkinsonian tremor and rigidity. New technology, including computed tomography-based stereotaxis and microelectrode recording techniques, provides a data base for precise localization of thalamic lesions tail...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)65215-x
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To verify whether absolute monocyte count (AMC) and lymphocyte- monocyte ratio (LMR) at diagnosis are valid prognostic parameters in classical Hodgkin lymphoma (cHL). PATIENTS AND METHODS:Data were collected from 1450 patients with cHL treated in Israel and Italy from January 1, 1988, through December 31, 20...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2015.03.025
更新日期:2015-06-01 00:00:00
abstract::The toxic shock syndrome has only recently been described. Eleven female patients aged 13 to 43 years (median 17) with toxic shock syndrome have been seen at the Mayo Clinic since August 1975. One patient died. Seven patients had one or more recurrences. As previously described, the syndrome was often life-threatening...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1980-11-01 00:00:00
abstract::Dural arteriovenous malformations of the transverse sinus are relatively well localized to the occipitomastoid regions and occur predominantly in women who are more than 40 years of age. The signs and symptoms, except for pulsatile tinnitus, vary and apparently depend on the presence of impaired venous drainage, which...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:
更新日期:1979-10-01 00:00:00
abstract:OBJECTIVE:To compare cardiovascular (CV) event rates and risk in patients without previous CV disease in whom atorvastatin or simvastatin was newly initiated in a managed care setting. PATIENTS AND METHODS:Patients aged 18 to 64 years in whom atorvastatin or simvastatin was newly initiated between January 1, 2003, and...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/S0025-6196(11)60779-9
更新日期:2008-12-01 00:00:00
abstract::Aerobic exercise training has been used as part of the treatment for a variety of chronic disorders, most notably cardiovascular disease. In order to determine the feasibility and utility of regular exercise after renal transplantation, the responses of 10 patients to graded exercise testing were compared before train...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)62329-5
更新日期:1987-09-01 00:00:00
abstract::Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even ...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章,评审
doi:10.1016/j.mayocp.2013.03.002
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the frequency of osteosarcoma involving the foot and determine the clinical outcome of affected patients. MATERIAL AND METHODS:We retrospectively reviewed the cases of osteosarcoma encountered between 1911 and 1992 at the Rizzoli Orthopedic Institute. In particular, we analyzed whether common cli...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/73.9.842
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:To determine whether the use of a computerized bar code-based blood identification system resulted in a reduction in transfusion errors or near-miss transfusion episodes. PATIENTS AND METHODS:Our institution instituted a computerized bar code-based blood identification system in October 2006. After instituti...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/j.mayocp.2012.12.010
更新日期:2013-04-01 00:00:00
abstract::Humanism and the humanities open the way to communication, to a better professional and political performance, and to a better image of the profession in the eyes of its "real" public. They also offer to individual physicians a richer life, a greater understanding of their own achievements, a protection against isolat...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.1016/s0025-6196(12)60703-4
更新日期:1993-09-01 00:00:00
abstract::We conducted a prospective, randomized trial to study the efficacy and tolerance of long-term versus short-term treatment with recombinant interferon alfa-2a in patients with chronic hepatitis B. Ten patients were randomly assigned to a 6-month interferon regimen, and 10 patients were assigned to a 3-week interferon t...
journal_title:Mayo Clinic proceedings
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0025-6196(12)62144-2
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:To describe management of patients with permanent pacemaker (PPM)- and implantable cardioverter-defibrillator (ICD)-related endocarditis. PATIENTS AND METHODS:We retrospectively reviewed all cases of infection involving PPMs and ICDs among patients presenting to Mayo Clinic's site in Rochester, MN, between J...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/83.1.46
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy and tolerability of weekly oral cyclophosphamide in combination with alternate-day prednisone (CP) as salvage therapy for patients with relapsed multiple myeloma (MM) after autologous stem cell transplantation (ASCT). PATIENTS AND METHODS:We retrospectively reviewed the medical records...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/80.12.1578
更新日期:2005-12-01 00:00:00
abstract:OBJECTIVE:To determine the effect of adding a trained intensivist on patient care and educational outcomes in a community teaching hospital. MATERIAL AND METHODS:We retrospectively reviewed outcomes for patients admitted to the medical intensive-care unit (MICU) of a 270-bed community teaching hospital between July 19...
journal_title:Mayo Clinic proceedings
pub_type: 杂志文章
doi:10.4065/72.5.391
更新日期:1997-05-01 00:00:00