Abstract:
:Elective root replacement in Marfan syndrome has improved life expectancy in affected patients. Three forms of surgery are now available: total root replacement (TRR) with a valved conduit, valve sparing root replacement (VSRR) and personalised external aortic root support (PEARS) with a macroporous mesh sleeve. TRR can be performed irrespective of aortic dimensions and a mechanical replacement valve is a secure and near certain means of correcting aortic valve regurgitation but has thromboembolic and bleeding risks. VSRR offers freedom from anticoagulation and attendant risks of bleeding but reoperation for aortic regurgitation runs at 1.3% per annum. A prospective multi-institutional study has found this to be an underestimate of the true rate of valve-related adverse events. PEARS conserves the aortic root anatomy and optimises the chance of maintaining valve function but average follow-up is under 5 years and so the long-term results are yet to be determined. Patients are on average in their 30s and so the cumulative lifetime need for reoperation, and of any valve-related complications, are consequently substantial. With lowering surgical risk of prophylactic root replacement, the threshold for intervention has reduced progressively over 30 years to 4.5 cm and so an increasing number of patients who are not destined to have a dissection are now having root replacement. In evaluation of these three forms of surgery, the number needed to treat to prevent dissection and the balance of net benefit and harm in future patients must be considered.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Treasure T,Takkenberg JJ,Pepper Jdoi
10.1136/postgradmedj-2013-305132repsubject
Has Abstractpub_date
2016-02-01 00:00:00pages
112-7issue
1084eissn
0032-5473issn
1469-0756pii
postgradmedj-2013-305132repjournal_volume
92pub_type
杂志文章abstract::Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms w...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.54.631.340
更新日期:1978-05-01 00:00:00
abstract::We describe two cases of digoxin toxicity presenting with clinical and electroencephalographic evidence of encephalopathy without other features of digoxin toxicity. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.72.848.367
更新日期:1996-06-01 00:00:00
abstract::Several aspects of the management of Crohn's disease (CD) are shared between patients. The goal of all therapies should be to achieve clinical and endoscopic remission in a timely manner to avoid disease progression and abdominal resections. The way this goal is achieved may differ and predicting how the disease will ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2012-303958rep
更新日期:2014-03-01 00:00:00
abstract::Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well toler...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.67.786.371
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:Workforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision. AIM:To assess doctors' views on the timing of choosing a clinical specialty. METHODS:Surveys of two...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2017-135460
更新日期:2018-11-01 00:00:00
abstract::Central venous catheterization is not without hazard. Inadvertent placement in the pleural space can occur without the development of a pneumothorax and pressure measurements may appear misleadingly normal. This case report illustrates an effective method of diagnosing and draining an iatrogenic hydrothorax which resu...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.66.778.672
更新日期:1990-08-01 00:00:00
abstract::The elderly, the very young, and the sick are known to be adversely affected by high environmental temperatures. In a retrospective open case-note review of 872 patients in a large institution during a hot summer we identified characteristics in the elderly that increase the risk of marginal hyperthermia. Women were m...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.71.834.213
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:Sleep deprivation and fatigue from long-shift work impacts doctors' personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK de...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2018-135795
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive. OBJECTIVE:To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation. SETTING:One year before and after interve...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2019-136992
更新日期:2021-02-01 00:00:00
abstract::Parasites in the human breast are uncommon but not rare. Cysticercus and filariasis in fine needle breast aspirates have been documented and their cytomorphology is well characterised. However, the host tissue response to these parasites and the factors responsible for their initiation are not clear. Over a 21 year pe...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pmj.78.917.165
更新日期:2002-03-01 00:00:00
abstract::Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.804.837
更新日期:1992-10-01 00:00:00
abstract::A 27 year old woman with hepato-lenticular degeneration (Wilson's disease) was found to have primary hepatocellular carcinoma (PHC) three and a half years after she was started on treatment with D-penicillamine. The tumour was resected since when she has remained well. Her liver function tests were normal throughout t...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.61.714.357
更新日期:1985-04-01 00:00:00
abstract::We report a case of persistent chorea as a manifestation of thyrotoxicosis. The chorea was severe and persisted after the patient was rendered euthyroid. Dopamine antagonists only partially suppressed the involuntary movements during the first few months. It was eventually controlled with haloperidol, but whenever she...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.756.789
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVE:To audit the current UK outpatient workload and compare this to the national standards as set out by the British Association of Urological Surgeons (BAUS) in A Quality Urological Service for Patients in the New Millennium published in October 2000. PARTICIPANTS:520 UK (NHS) and 21 Republic of Ireland (non-NH...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/pgmj.2004.020693
更新日期:2005-01-01 00:00:00
abstract::Two-hundred and nine patients were entered into a prospective, randomized trial in order to determine whether a vertical or transverse abdominal incision is the more satisfactory in producing sound wounds. Ninety-six patients were randomized between paramedian and transverse incisions, and followed up for at least 1 y...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.60.704.407
更新日期:1984-06-01 00:00:00
abstract::A patient with a poorly differentiated clear cell adenocarcinoma of the ovary presenting as pyrexia of unknown origin is reported. Following resection of the tumour, her pyrexia resolved completely. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.61.712.177
更新日期:1985-02-01 00:00:00
abstract:PURPOSE OF THE STUDY:There are approximately 35 000 in-hospital cardiac arrests in the UK each year. Successful resuscitation requires integration of the medical science, training and education of clinicians and implementation of best practice in the clinical setting. In 2015, the International Liaison Committee on Res...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2016-134732
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:The diagnosis of spinal tuberculosis (ST) is difficult and it commonly presents at an advanced stage. The management and follow up is complicated by a lack of guidance on the appropriate use and interpretation of spinal magnetic resonance studies (MR). AIMS:A retrospective study was performed at a UK centre...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2005.032862
更新日期:2006-01-01 00:00:00
abstract::Colonoscopies performed in patients aged 80 years or older at the Sheba Medical Center were analysed according to the primary indication for the procedure: 101 colonoscopies were performed because of rectal bleeding of at least 2 months duration, and 335 for all other indications. Carcinoma of the large bowel was foun...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.799.355
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Essential Skills in the Management of Surgical Cases (ESMSC) is a novel 3-day international undergraduate surgical masterclass. Its current curriculum (Cores integrated for Research-Ci4R) is built on a tetracore, multiclustered architecture combining high-fidelity and low-fidelity simulation-based learning (...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2017-135479
更新日期:2018-05-01 00:00:00
abstract::Herpes simplex encephalitis may be underdiagnosed in Britain. We report eight patients treated at one hospital over three years. Fever, impaired consciousness or focal neurological signs were seen in all patients at presentation but herpes simplex encephalitis was rarely considered as the initial diagnosis. The electr...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.63.746.1037
更新日期:1987-12-01 00:00:00
abstract::Hypercalcaemia occurs in up to 80% of patients with adult T-cell leukaemia-lymphoma (ATLL) associated with human T-cell leukaemia virus-1 infection. Elevated serum levels of 1,25-dihydroxycholecalciferol, implicated in the pathogenesis of hypercalcaemia in lymphoma, and of parathyroid hormone-related protein (PTHrP), ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.803.753
更新日期:1992-09-01 00:00:00
abstract::We describe a patient with primary amyloidosis in whom multiple osteolytic lesions caused by amyloid bone tumours developed, and review the clinical features of the 18 cases with primary amyloidosis in whom destructive bone lesions have been reported. In contrast to amyloidosis associated with multiple myeloma, destru...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.62.733.1037
更新日期:1986-11-01 00:00:00
abstract::Churg-Strauss syndrome is a systemic vasculitis. Its most frequent complications are heart diseases and asthma. Usually, cardiological manifestations are pericarditis, cardiac failure and myocardial infarction. Endobronchial granulomas identified by bronchoscopy are unusual. We present the case of a man with congestiv...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.71.836.365
更新日期:1995-06-01 00:00:00
abstract:BACKGROUND:Primary percutaneous coronary intervention (PPCI) programmes vary in admission criteria from open referral to acceptance of electrocardiogram (ECG) protocol positive patients only. Rigid criteria may result in some patients with acutely occluded coronary arteries not receiving timely reperfusion therapy. OB...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2012-130818
更新日期:2013-07-01 00:00:00
abstract::Despite the remarkable advances in cardiovascular therapeutics over the past four decades, little impact has been made on either the incidence or mortality rate of congestive heart failure and it remains a major clinical and public health problem. Recent practice audits have suggested that proven efficacious therapies...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.73.858.194
更新日期:1997-04-01 00:00:00
abstract::The first case of the Zollinger-Ellison syndrome treated from the outset continuously for more than a year with the histamine H2-receptor antagonist cimetidine is reported. Symptomatic response has been dramatic and sustained, marked endoscopic improvement has been observed with healing of oesophageal, gastric and sto...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.53.626.749
更新日期:1977-12-01 00:00:00
abstract::Patients with acquired von Willebrand disease may present with severe bleeding, which is usually difficult to manage. Adequate haemostasis in acquired von Willebrand disease may be achieved with the infusion of factor VIII/von Willebrand factor concentrates or with the administration of desmopressin. We report a case ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.70.830.916
更新日期:1994-12-01 00:00:00
abstract::Acute loss of vision and alcoholic intoxication suggests the possibility of methanol poisoning. In this report we describe an alcoholic patient who complained of blindness after recovering from alcoholic pancreatitis and delirium tremens. Visual acuity was severely impaired and fundoscopy revealed florid bilateral cot...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.69.808.151
更新日期:1993-02-01 00:00:00
abstract::In 40 hypertensive patients continuous ECG recording was done before and after 30 days treatment with indapamide 2.5 mg. There was no change in heart rate. In addition, the incidence of extrasystoles was not changed in patients in whom the ECG was normal before treatment (30 cases) or in 8 of the 10 patients who had a...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00