Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making.

A great number of Guidelines and Expert Consensus Documents have been issued in recent years by different organisations, the European Society of Cardiology (ESC) and by other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents.

In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied within the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources.

The ESC Committee for Practice Guidelines ( CPG ) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups or consensus panels. The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements.

The strength of evidence related to a particular diagnostic or treatment option depends on the available data: (1) level of evidence A: multiple …

https://www.tjh.com.cn/plmnhytf12f3/d27f053da171cc90/PDF文件/ESC%202004%20心包疾病诊断和治疗指南587.pdf

Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology.

Recent evidence implicates Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis. This paper reviews the morphological, biochemical and serological charcteristics of A. actinomycetemcomitans, evidence incriminating it as a periodontopathogen, its importance in human nonoral infections, and virulence factors which may be involved in the pathogenesis of A. actinomycetemcomitans infections. A. actinomycetemcomitans is a non-motile, gram-negative, capnophilic, fermentative coccobacillus which closely resembles several Haemophilus species but which does not require X or V growth factors. The organism has been categorized into 10 biotypes based on the variable fermentation of dextrin, maltose, mannitol, and xylose and into 3 serotypes on the basis of heat stable, cell surface antigens. A. actinomycetemcomitans' primary human ecologic niche is the oral cavity. It is found in dental plaque, in periodontal pockets, and buccal mucosa in up to 36% of the normal population. The organism can apparently seed from these sites to cause severe infections throughout the human body such as brain abscesses and endocarditis. There is a large body of evidence which implicates A. actinomycetemcomitans as an important micro-organism in the etiology of localized juvenile periodontitis including: (1) an increased prevalence of the organism in almost all localized juvenile periodontitis patients and their families compared to other patient groups; (2) the observation that localized juvenile periodontitis patients exhibit elevated antibody levels to A. actinomycetemcomitans in serum, saliva and gingival crevicular fluid; (3) the finding that localized juvenile periodontitis can be successfully treated by eliminating A. actinomycetemcomitans from periodontal pockets; (4) histopathologic investigations showing that A. actinomycetemcomitans invades the gingival connective tissue in localized juvenile periodontitis lesions; (5) the demonstration of several pathogenic products from A. actinomycetemcomitans including factors which may: (a) facilitate its adherence to mucosal surfaces such as capsular polysaccharides; (b) inhibit host defense mechanisms including leukotoxin, a polymorphonuclear leukocyte chemotaxis inhibiting factor, and a lymphocyte suppressing factor (c) cause tissue destruction such as lipopolysaccharide endotoxin, a bone resorption-inducing toxin, acid and alkaline phosphatases, collagenase, a fibroblast inhibiting factor and an epitheliotoxin.(ABSTRACT TRUNCATED AT 400 WORDS)

Actinobacillus actinomycetemcomitans in human periodontal disease

Longterm Follow-up of Patients with Pulmonary Thromboembolism: Late Prognosis and Evolution of Hemodynamic and Respiratory Data

The Marfan syndrome is a dominantly inherited disorder of connective tissue with multisystem involvement. The cardiac complications, particularly aortic dilatation, dissection and rupture and involvement of the aortic and mitral valves, lead to a greatly reduced life expectancy. This poor survival was demonstrated in a series of 257 patients with the Marfan syndrome. The average age at death for the 72 deceased patients was 32 years. Cardiac problems led to 52 of the 56 deaths of known cause, with aortic dilatation and its complications accounting for 80 per cent of these. Congestive heart failure, myocardial infarction and bacterial endocarditis were other cardiac causes of death. In patients with early aortic changes treatment with propranolol or reserpine is suggested. These agents decrease myocardial contractility and diminish the pulsatile flow stress on the weakened aorta.

Life Expectancy and Causes of Death in the Marfan Syndrome

The use of ultrasound has developed over the last 50 years into an indispensable first-line test for the cardiac evaluation of symptomatic patients. The technologic miniaturization and improvement in transducer technology, as well as the implementation of educational curriculum changes in residency training programs and specialty practice, have facilitated the integration of focused cardiac ultrasound into practice by specialties such as emergency medicine. In the emergency department, focused cardiac ultrasound has become a fundamental tool to expedite the diagnostic evaluation of the patient at the bedside and to initiate emergent treatment and triage decisions by the emergency physician.

Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians

Atraumatic so-called "spontaneous" rupture of the esophagus. A review of 47 personal cases with comments on a new method of surgical therapy.

https://www.annalsthoracicsurgery.org/article/0003-4975(92)91177-B/pdf

Rupture of the airways from blunt trauma: treatment of complex injuries

Two cases of symptomatic myocardial bridging of the left anterior descending coronary artery requiring surgery for relief are reported. One patient experienced the sudden onset of ventricular fibrillation, had evolving electrocardiographic evidence of an anterior myocardial infarction and subsequently continued to have chest pain. The second patient presented with a long-standing history of repeated episodes of paroxysmal supraventricular tachycardia accompanied by chest pain. During one such episode he had prolonged chest pain and a syncopal episode, but evidence for myocardial necrosis did not develop. On coronary arteriography the only abnormality noted was severe systolic narrowing of the left anterior descending coronary artery in the first patient and similar narrowing of both this artery and a large diagonal vessel in the second. Each patient successfully underwent coronary arterial debridging and, in addition, had a bypass graft to the distal left anterior descending artery. Both patients are In stable condition and show considerable improvement 46 and 9 months, respectively, after operation. Although in most cases of bridging detected on coronary arteriography there is no evidence of ischemic heart disease, the occurrence of symptoms with tachycardia and, in particular, the unusual length of the bridged segments and the severity of systolic narrowing may have played a significant role in the development of disease in these two patients.

Symptomatic myocardial bridging of coronary artery

The traditional management of acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. The recommendation for this treatment is primarily based on the premise that as many as 90% of patients will die within the first 24 hours after their injury. 1,2 Immediate repair of the transected aorta has been associated with a surgical death rate of 0% to 54.2%. 3 This high death rate is often due to the other associated injuries that may be present in the major trauma patient. Delayed repair of the acute aortic tear, allowing the patient to recover from other major injuries, has been reported in the literature with increasing frequency. 4–9 This review was conducted to determine the safety of delayed repair of acute rupture of the thoracic aorta, and this strategy’s impact on the patient’s outcome.

Traumatic rupture of the aorta: immediate or delayed repair?

The management of retained missiles in the heart is still controversial. In an attempt to define the issue more clearly, the reported cases in the English literature from 1940 to 1988 (group 1) and our experience from 1968 to 1988 (group 2) were reviewed. In group 1 there were 222 missiles retained in the hearts of 201 patients. The retained missiles were 45 bullets in 45 patients, 109 shrapnel in 99 patients, 18 pellets in 7 patients, and 50 unidentified missiles in 50 patients. Thirteen of the missiles were completely embedded intramyocardial missiles, 122 were partially intramyocardial, 47 were free in a cardiac chamber, and 40 were intrapericardial. One hundred four of the missiles were removed and 118 were left in place. In group 2 there were 24 missiles, 18 bullets, 1 bullet fragment, and 5 pellets retained in the hearts of 24 patients. Ten missiles were removed, no attempt was made in 13 patients, and an unsuccessful attempt was made to remove one other. From group 1 patients, 6 died, 2 with intracavitary missiles, 3 patients with partially intramyocardial, and 1 patient with an intrapericardial missile, all of whom had either unsuccessful or no attempt to remove the missile. Twenty-seven patients had symptoms, all of whom, except two, had either unsuccessful or no attempt to remove the missile. All group 2 patients did well and had been free of symptoms related to the missiles. This review suggests that the management of missiles in the heart should be individualized according to the patient's clinical course, the site, shape, and size of the missile, and that in selected patients missiles in the heart are tolerated well.

Panagiotis N. Symbas

Papers

Atraumatic so-called "spontaneous" rupture of the esophagus. A review of 47 personal cases with comments on a new method of surgical therapy.

Rupture of the airways from blunt trauma: treatment of complex injuries

Symptomatic myocardial bridging of coronary artery

Traumatic rupture of the aorta: immediate or delayed repair?

Cardiac missiles. A review of the literature and personal experience.