Mayo Clinic

About: Mayo Clinic is a healthcare organization based out in Rochester, Minnesota, United States. It is known for research contribution in the topics: Population & Cancer. The organization has 63387 authors who have published 169578 publications receiving 8114006 citations.

Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea

Abstract: Background—Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular and cerebrovascular disease. Inflammatory processes associated with OSA may contribute to cardiovascular morbidity in these patients. We tested the hypothesis that OSA patients have increased plasma C-reactive protein (CRP). Methods and Results—We studied 22 patients (18 males and 4 females) with newly diagnosed OSA, who were free of other diseases, had never been treated for OSA, and were taking no medications. We compared CRP measurements in these patients to measurements obtained in 20 control subjects (15 males and 5 females) who were matched for age and body mass index, and in whom occult OSA was excluded. Plasma CRP levels were significantly higher in patients with OSA than in controls (median [range] 0.33 [0.09 to 2.73] versus 0.09 [0.02 to 0.9] mg/dL, P0.0003). In multivariate analysis, CRP levels were independently associated with OSA severity (F6.8, P0.032). Conclusions—OSA is associated with elevated levels of CRP, a marker of inflammation and of cardiovascular risk. The severity of OSA is proportional to the CRP level. (Circulation. 2002;105:2462-2464.)

Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever

Abstract: Background Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative. Methods In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy. Results A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, –10.6 to 1.6 percentage points); these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors. There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal a...

Traumatic instability of the wrist: diagnosis, classification, and pathomechanics.

Abstract: The scaphoid is a mechanical link that stabilizes the intercarpal joint during motions of the wrist. Without this stability the proximal carpal row acts as an unsupported intercalated link in a three-link system and zigzag collapse occurs with axial loading. A deformity with dorsiflexion of the lunate within the linkage (dorsiflexion instability) occurs commonly after scaphoid fracture and scapholunate dissociation. When dissociation occurs the scaphoid assumes a vertical position, that is, the angle formed by the longitudinal axes of the scaphoid and the lunate approaches a right angle. Rupture of the distal attachments of the palmar radiocarpal ligament and of the scapholunate ligament appears to induce dissociation. It is therefore concluded that ligamentous injury along with scaphoid fracture is probably necessary if dorsiflexion instability is to develop. Palmar flexion instability characterized by palmar flexion of the lunate within the wrist linkage appears to be associated with ulnar displacement of the carpus as is seen in rheumatoid arthritis or after loss of the distal end of the ulna. This position may be normal in a small percentage of patients. The direction of the intercarpal collapse is related to the location of the pressure of the head of the capitate against the concave surface of the lunate, that is, whether this pressure is dorsal or palmar to the plane of the radiolunate fulcrum on the proximal convex surface of the lunate. The direction of the collapse is also related to the normal oblique path of motion (rotation and sliding) of the capitate during ulnar and radial deviation and is intimately controlled by the geometric configuration of the bones and the resultant of forces on the carpus. These forces are determined by the strength, direction, and leverage of the musculotendinous units, which cross the joints of the wrist complex.

Estimated Radiation Dose Associated With Cardiac CT Angiography

Abstract: Context Cardiac computed tomography (CT) angiography (CCTA) has emerged as a useful diagnostic imaging modality in the assessment of coronary artery disease. However, the potential risks due to exposure to ionizing radiation associated with CCTA have raised concerns. Objectives To estimate the radiation dose of CCTA in routine clinical practice as well as the association of currently available strategies with dose reduction and to identify the independent factors contributing to radiation dose. Design, Setting, and Patients A cross-sectional, international, multicenter, observational study (50 study sites: 21 university hospitals and 29 community hospitals) of estimated radiation dose in 1965 patients undergoing CCTA between February and December 2007. Linear regression analysis was used to identify independent predictors associated with dose. Main Outcome Measure Dose-length product (DLP) of CCTA. Results The median DLP of 1965 CCTA examinations performed at 50 study sites was 885 mGy × cm (interquartile range, 568-1259 mGy × cm), which corresponds to an estimated radiation dose of 12 mSv (or 1.2 × the dose of an abdominal CT study or 600 chest x-rays). A high variability in DLP was observed between study sites (range of median DLPs per site, 331-2146 mGy × cm). Independent factors associated with radiation dose were patient weight (relative effect on DLP, 5%; 95% confidence interval [CI], 4%-6%), absence of stable sinus rhythm (10%; 95% CI, 2%-19%), scan length (5%; 95% CI, 4%-6%), electrocardiographically controlled tube current modulation (−25%; 95% CI, −23% to −28%; applied in 73% of patients), 100-kV tube voltage (−46%; 95% CI, −42% to −51%; applied in 5% of patients), sequential scanning (−78%; 95% CI, −77% to −79%; applied in 6% of patients), experience in cardiac CT (−1%; 95% CI, −1% to 0%), number of CCTAs per month (0%; 95% CI, 0%-1%), and type of 64-slice CT system (for highest vs lowest dose system, 97%; 95% CI, 88%-106%). Algorithms for dose reduction were not associated with deteriorated diagnostic image quality in this observational study. Conclusions Median doses of CCTA differ significantly between study sites and CT systems. Effective strategies to reduce radiation dose are available but some strategies are not frequently used. The comparable diagnostic image quality may support an increased use of dose-saving strategies in adequately selected patients.