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10/2011; , ISBN: 978-953-307-660-7
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ABSTRACT: Chronic aortic regurgitation results in left ventricular (LV) dilation, increased LV work and, eventually, a decline in LV function and heart failure. An important question is whether pharmacological therapy could preserve LV function and delay the need for aortic valve replacement. Vasodilators have a number of theoretical advantages. By lowering blood pressure, they reduce the regurgitant volume and decrease LV afterload. This article summarizes the clinical studies that have evaluated vasodilators in asymptomatic patients with chronic aortic regurgitation. Some studies suggest favorable effects on LV function and clinical outcomes, but results are inconsistent, making it difficult to draw definite conclusions. In general, studies have been too small to reliably evaluate the overall benefits and risks of this treatment, and in several studies there was no significant difference in measured blood pressure by treatment allocation. For these reasons, decisions on whether vasodilators are indicated in individual patients must currently be based on clinical judgment alone.
Expert Review of Cardiovascular Therapy 09/2011; 9(9):1249-54.
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ABSTRACT: To review the presentation and associated congenital abnormalities of laryngeal cleft and present guidelines for its evaluation and management.
A 10-year retrospective study (1994-2004) with institutional review board approval.
Two pediatric tertiary care medical centers.
Twenty-two pediatric patients (mean age, 21 months) with laryngeal cleft.
Surgical repair of laryngeal cleft.
Sex, age, symptoms, other associated abnormalities, method of evaluation, type of laryngeal cleft, method of surgical repair, treatment outcome, complications, and long-term follow-up.
All 22 patients underwent surgical repair for laryngeal cleft. Airway endoscopy confirmed the following types of laryngeal clefts: type 1 (n = 3), type 2 (n = 10), and type 3 (n = 9). Surgical repair techniques included an open approach with or without interposition graft (n = 16) and an endoscopic approach (n = 6).
Early diagnosis and proper repair of laryngeal cleft are essential to prevent pulmonary damage and associated morbidity. Each patient should be assessed properly, and the surgical approach should be individualized based on the symptoms, other associated findings on airway endoscopy, and type of cleft.
Archives of Otolaryngology - Head and Neck Surgery 01/2007; 132(12):1335-41. · 1.63 Impact Factor
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ABSTRACT: The current recommendation for the choice of empiric antibiotic therapy of chronic rhinosinusitis is based on the bacteriology of acute rhinosinusitis. Staphylococcus aureus has been found consistently in cultures from patients with chronic rhinosinusitis. New studies have examined the role of Staphylococcus aureus in the pathogenesis and clinical course of chronic rhinosinusitis, both before and after surgical therapy. The consequence of antibiotic resistance, on the course of chronic rhinosinusitis and its treatment, has also been examined.
Several recent studies have confirmed past literature demonstrating a high incidence of sinus cultures positive for Staphylococcus aureus growth in patients with chronic rhinosinusitis. Moreover, one study reported that Staphylococcus aureus is common in patients with persistent chronic rhinosinusitis after endoscopic sinus surgery. These studies, however, have not shown that this bacterium is a significant factor in the development of chronic rhinosinusitis or a predictor of the severity of symptoms. Other studies did not support the notion of increased antibiotic resistance in chronic rhinosinusitis, although there is some evidence that antibiotic resistance may lead to refractory cases of the disease. The standard treatment, of multiple courses of empiric antibiotics followed by surgery, was not shown to increase the prevalence of methicillin-resistant Staphylococcus aureus.
A review of recent literature shows a high incidence of positive cultures for Staphylococcus aureus from the sinuses of patients with chronic rhinosinusitis, both before and after surgery, but has not produced convincing evidence that Staphylococcus aureus has a significant role in the pathogenesis or clinical course of the disease.
Current Opinion in Otolaryngology & Head and Neck Surgery 03/2006; 14(1):19-22. · 1.83 Impact Factor
