Thèses sur le sujet « Paroxysms »
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1
Eldridge, Ben Matthew. « I, Becoming : Peter Watts’ Functionally Generative Linguistic Paroxysms ». Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23472.
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Peter Watts’ fiction is frequently described as bleak, misanthropic and dystopian, amongst a range of other equally grim epithets. Indeed, the oeuvre of this contemporary Canadian science fiction writer is unquestionably harsh and unforgiving, extrapolating realities in which even technologically augmented (post)humanity is virtually obsolete. However, for all the apparent narrative nihilism, it is Watts’ idiosyncratic prose that is the most subversive part of his output; the irony of Watts’ textual production is that its very fabric – language – is the thing that finds itself under attack. As this project navigates Watts’ codified linguistic expression, his texts will be shown to stand as synecdochic representatives for the difficulty of considering language, and the grammar on which it relies, as a disinterested form of communication. En route, we shall find that semantic content and syntactical construction of discourse are equally significant in the incipience of meaning, and that it is from the complex negotiation of form and content in Watts’ work – and its subversive relationship to the broader media ecology of which it is a part – that a singular textual ambiguity emerges. Embodied language structures, defines and creates our world, and Watts’ work demonstrates the linguistic tendency towards perceptual distortion and fallibility.
2
Fisher, Michael. « Clozapine-induced paroxysmal discharges ». Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/2190.
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The atypical antipsychotic clozapine is a widely prescribed and effective treatment for the positive and negative symptoms of schizophrenia, but reports of side effects are common. In one study EEG abnormalities were observed in 53% of patients treated with clozapine, and the absence or presence of EEG abnormalities correlated with the plasma clozapine concentration. Here, epileptiform activity was present in conventional EEG recordings from a 32 year old male patient with psychiatric illness taking clozapine for 3 weeks. Brief (ca.100ms), transient epileptiform spikes occurred at a frequency of approximately 2 per h and originated primarily in parietal cortex. One month after withdrawal of clozapine, epileptiform spikes were no longer present. An in vitro model was developed using the equivalent region of association cortex, namely 2⁰ somatosensory cortex, in normal rat brain slices to probe such activity with increased spatial and temporal resolution, and to investigate mechanisms underlying its generation. Wide band in vitro recordings revealed that clozapine (10-20µM) induced regular, frequent very fast oscillations (VFO, > 70Hz) in this region. These VFO comprised short transient high frequency discharges and were maximal in patches along layer V. The atypical antipsychotic olanzapine, but not the classical antipsychotic haloperidol, also induced prominent VFO in this region. Sharp electrode intracellular recordings revealed that there was almost no correlation between the somatic activity of layer V regular spiking (RS) pyramidal cells and field VFO, but layer V intrinsically bursting (IB) cells did correlate to some extent with the local field. Interestingly, IB cell spikelets were also weakly correlated with field VFO suggesting a role for axonal hyperexcitability in this cell type in the mechanism. Clozapine-induced VFO persisted following blockade of AMPA, NMDA, and GABAA chemical synaptic receptors, and the gap junction blockers carbenoxolone and quinine also failed to significantly attenuate the power of this activity. Although octanol abolished clozapine-induced VFO, it was not clear that this effect resulted from blockade of gap junctions as this drug also blocks spikes. In addition to VFO events, clozapine (10-20µM) also induced occasional, spontaneous transient paroxysmal discharges, similar to the EEG phenomena, in 33% (11/33 slices) of slices in vitro. Sharp electrode intracellular recordings revealed that clozapine- induced full paroxysmal discharges were associated with spikes, EPSPs and IPSPs in layer V RS and IB cells, suggesting that these events were mediated via chemical synaptic transmission in both of these cell types. Multi-electrode array recordings of local field potentials and units suggested that clozapine-induced paroxysmal events started superficially in association cortex, moved deeper and then propagated horizontally along these deep layers. The onset of clozapine-induced VFO was accompanied by a significant elevation in parvalbumin immunoreactivity, particularly in layer II-IV, where there was a greater than twofold increase in the signal, and this may be relevant to the therapeutic action of the drug.
3
Akin, Faith W. « Benign Paroxysmal Positioning Vertigo ». Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/2437.
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Kassius, Love. « Kritik av den Rena Ondskan eller Förnuftets Paroxysm ». Thesis, Södertörns högskola, Institutionen för kultur och lärande, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-34844.
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This essay tries to lay the transcendental foundations to a notion of “pure evil”, pure in the Kantian sense of the term, which means to find the necessary conditions for the concept and establish which criteria must be in place for such a concept to be justified. This essay tries to show the importance of thinking evil on its own terms instead as a secondary concept derived from ”the Good”. The prevailing philosophical stance from Platon until Kant has been to treat evil as either privation or unreason; this paper instead seeks to formulate a substantive notion of evil as pure evil, showing how it can be thought in its own right as an independent and self-sufficient concept. From a Kantian perspective it is only practical reason that can ground a moral action or maxim as free and self-determined, therefore a true concept of evil is only possible at level of the moral law i.e. the source of reason itself. Hence this paper argues that pure evil is intimately linked to the functioning of pure reason itself. In contrast to the traditional thinking regarding the issue of evil, I argue that reason is the sole source of pure evil and that no other factors such as pathology, affect or bad faith can account for events or actions that demonstrates the characteristics of pure evil. With help from the groundbreaking work of Kant, Arendt, Lacan and Sade I hope to point towards a new understanding of the concept of evil as a product of reason itself. Hopefully this work manages to show how and why such a perspective is needed and makes clear what we might gain from such an analysis.
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Kelly, Richard John. « The pathophysiology of paroxysmal nocturnal haemoglobinuria ». Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/6820/.
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Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, life-threatening condition caused by an expansion of a clone of haemopoietic stem cells (HSC) harboring a somatic mutation of the PIG-A gene. PNH blood cells are deficient in glycophosphatidylinositollinked (GPI) proteins rendering PNH erythrocytes susceptible to complement attack which leads to intravascular haemolysis and an increased tendency to develop thromboses. The survival of 79 consecutive patients treated with eculizumab was compared to both age and sex matched normal controls and to 30 similar patients managed in the era immediately prior to anti-complement therapy. The survival of those treated with eculizumab was no different that of the control group and was significantly better than the group with PNH that did not receive eculizumab (p=0.3). Transfusion requirements and documented thromboses were reduced with eculizumab. Sixty-six percent of transfusion dependent patients became transfusion independent and thrombotic events reduced from 5.6 to 0.8 events per 100 years. Eleven women were monitored through 15 pregnancies whilst on eculizumab. There was 1 first trimester miscarriage and 15 healthy babies born. There were no maternal deaths observed and no thrombotic events occurred in the pregnancy or the postpartum period. Eculizumab did not appear to cross the placenta or be expressed in breast milk. Thirty-five patients were evaluated for PIG-M mutations to see if this mutation was prevalent in PNH. No PIG-M promoter mutations were identified. Two genes were evaluated to see if secondary mutations affecting them could account for clonal expansion in PNH. Thirty-six patients underwent JAK2 V617F mutation analysis with 1 patient shown to have a JAK2 mutation. Forty-two patients were evaluated for increased HMGA2 levels by 2 different PCR methods. There was an overall reduction in HMGA2 expression in PNH patients as compared to normal controls. An in vitro model of the bone marrow in PNH was developed and 18 PNH bone marrow samples were evaluated using this model. Colony forming assays (CFA) showed an increase in colony formation when T-cells were removed from the PNH bone marrow samples. This improvement was reversed when the T-cells were added back to the experiments. This work supports an immune mechanism for the expansion of the PNH clone.
6
Comby, Jacques. « Les paroxysmes pluviométriques dans le couloir rhodanien et ses marges ». Lyon 3, 1998. http://www.theses.fr/1998LYO31001.
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Après avoir défini le paroxysme climatique selon l'approche physique des phénomènes, l'introduction générale souligne le caractère multidimensionnel de ces évènement qui constituent des risques majeurs pour les populations. Une première partie présente les conditions dynamiques qui déterminent le temps dans le sillon rhodanien et ses marges. L'analyse constitue un rappel des conditions dynamiques moyennes du domaine climatique de l'Atlantique nord et de l'Eurasie qui, en relation avec les facteurs régionaux et locaux, déterminent les composantes moyennes du temps dans le couloir rhodanien et ses marges. Dans une deuxième partie, 24 études de cas de systèmes pluvio-orageux organisés mettent en évidence la simplicité et la faible originalité des mécanismes qui sont à l'origine des épisodes paroxysmiques de précipitations liquides, de grêle et de neige, dans le couloir rhodanien. Au total, l'analyse de 126 situations permet de dégager une typologie des situations à risque. La troisième partie réservée à l'approche statistique des paroxysmes, souligne les contraintes qui s'imposent à l'analyse et justifie des modèles retenus pour l'exploitation des données. L'analyse des résultats confirme la forte concentration des précipitations intenses au sud du couloir en automne. Elle met aussi en évidence la variabilité du seuil catastrophique des phénomènes selon les échelles d'espace et de temps considérées, et montre que ces phénomènes sont une composante àpart entière du temps de la région étudiée. La récente tendance à la hausse des paroxysmes pluviométriques, associée, et comparée à l'évolution d'autres paramètres climatiques apparait comme l'un des signes annonciateurs d'un durcissement des conditions climatiques dans le couloir rhodanien. La quatrième partie rappelle l'impact des paroxysmes sur les populations du couloir rhodanien. Une attention particulière est accordée aux facteurs qui conditionnent à la fois : l'appréciation et l'estimation des phénomènes, les alternatives et le choix des actions envisagées pour lutter contre les risques. En conclusion générale, l'accent est mis sur les nécessité d'une plus grande vigilance face à l'augmentation récente des paroxysmes pluviométriques dans le couloir rhodanien. Elle souligne que dans cette perspective, la politique globale de prévention des risques doit procéder à une révision des modèles climatiques de prévision et à une redéfinition des moyens de prévention contre les risques.
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RAFFO, EMMANUEL MONIN PIERRE. « EPILEPSIE IDIOPATHIQUE A PAROXYSMES FRONTAUX A PROPOS DE 5 OBSERVATIONS / ». [S.l.] : [s.n.], 2000. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2000_RAFFO_EMMANUEL.pdf.
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Thomas, Rhys Huw. « Phenotyping paroxysmal conditions to empower genetic research ». Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/44849/.
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I describe the process of preparing cohorts of individuals with two paediatric onset paroxysmal disorders – hyperekplexia and juvenile myoclonic epilepsy – for second generation sequencing. This involves: i) listening to the individual; ii) identifying subgroups; iii) using non-‐core features to create subgroups; iv) and assessing the importance of copy number variation. Using focus groups and an interpretative phenomenological approach clinicians and people with epilepsy produced 398 questions focused on epilepsy treatment. The most important themes for the professionals were – teatment pogrammes or non-‐epileptic attack disorder and concerns about side effectsinutero.For patients cognitive drug side effects and managing the consequences of drug side effects were most important. Studying ninety-‐seven individuals with hyperekplexia confirmed that all gene-‐positive cases present in the neonatal period and that clonazepam is the treatment of choice (95% found it efficacious). Patients with SLC6A5 and GLRB mutations were more likely to have developmental delay (RR1.5 p<0.01; RR1.9 p<0.03) than those with GLRA1 mutations; 92% of GLRB cases reported a mild to severe delay in speech acquisition. Juvenile myoclonic epilepsy is challenging to subdivide based on seizure and EEG features. The neuropsychological profile of limited number of patients 39) as examined in great detail including tests Q WAIS), emory TYM,WMS),executive function (BADS, DKEFS), affect (HADS). TYM was as sensitive as a full WMS for identifying cognitive errors and the zoo map and key search tests were performed particularly poorly. Personality profiling (EPQ-‐BV) identifies the cohort as having high levels of neurotic and introvert traits. Three atypical ‘hyperekplexia’ cases had alternative diagnoses suggested by copy number analysis. The juvenile myoclonic epilepsy patients had an 8% frequency of recognised pathogenic CNVs– but no recurrent variants were identified.A number of non-‐epilepsy related findings were identified including a potentially preventable cause of SUDEP.
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Riska, Kristal M., Faith W. Akin, Laura Williams, Stephanie B. Rouse et Owen D. Murnane. « A Benign Paroxysmal Positional Vertigo Triage Clinic ». Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1779.
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Purpose: The purpose of this study was to evaluate the effectiveness of triaging patients with motion-provoked dizziness into a benign paroxysmal positional vertigo (BPPV) clinic.
Method: A retrospective chart review was performed of veterans who were tested and treated for BPPV in a triaged BPPV clinic and veterans who were tested and treated for BPPV in a traditional vestibular clinic.
Results: The BPPV triage clinic had a hit rate of 39%. On average, the triaged BPPV clinic reduced patient wait times by 23 days relative to the wait times for the traditional vestibular clinic while also reducing patient costs.
Conclusion: Triaging patients with BPPV is one method to improve access to evaluation and treatment and a mechanism for the effective use of clinic time and resources.
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Akin, Faith W., A. Lynn Williams, Courtney D. Hall, Stephanie M. Byrd et Owen D. Murnane. « A Benign Paroxysmal Positional Vertigo Specialty Clinic ». Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/1889.
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Akin, Faith W. « Benign Paroxysmal Positional Vertigo : Assessment and Treatment ». Digital Commons @ East Tennessee State University, 1998. https://dc.etsu.edu/etsu-works/2458.
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Kapur, Atul Kumar. « Emergency department treatment of clinically stable paroxysmal atrial fibrillation ». Thesis, University of Ottawa (Canada), 2002. http://hdl.handle.net/10393/6228.
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Introduction. Optimal management of paroxysmal atrial fibrillation (PAF), a common presenting complaint in emergency departments (EDs), remains undetermined. Methods. Six month prospective observational study at three EDs. Patients had clinically stable PAF for less than 48 hours. Conservative (rate control) and aggressive (pharmacologic and/or electrical cardioversion) treatment were analyzed. Results. 169 patients were analyzed, 32 treated conservatively and 137 aggressively. 83.9% of aggressively treated patients converted in the ED, 8.0% were admitted, and 52.3% stayed in sinus rhythm for four weeks. The corresponding proportions for conservative treatment were 34.4%, 37.5%, and 30.0%. There were 15 ED complications (2 rate control, 4 pharmacologic, and 9 electrical), two required admission (one pharmacologic and one electrical). No thromboembolism occurred by four-week follow-up. Conclusions. The results of this study---the first prospective study of ED treatment of PAF---will be used to plan a randomized controlled trial which will compare the two treatments.
13
Karadimitris, Anastasios. « Investigation of the cellular pathogenesis of paroxysmal nocturnal haemoglobinuria ». Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248019.
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Hillmen, Peter. « The biochemical and cellular basis of paroxysmal nocturnal haemoglobinuria ». Thesis, Imperial College London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338391.
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Elebute, Modupe Olaitan. « Evaluation of haemopoiesis in de-novo haemolytic paroxysmal nocturnal haemoglobinuria ». Thesis, St George's, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271169.
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Steckley, James L. « Investigation into the genetic aspects of acetazolamide-responsive paroxysmal vestibulocerebellar ataxia ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ32512.pdf.
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Bauer, P. R. « Dynamics of brain states and cortical excitability in paroxysmal neurological conditions ». Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1522273/.
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Epilepsy and migraine are neurological conditions that are characterised by periods of disruption of normal neuronal functioning. Aside from this paroxysmal feature, both conditions share genetic mutations and altered cortical excitability. People with epilepsy appear to be diagnosed with migraine more often than people without epilepsy and, likewise, people with migraine seem to be diagnosed with epilepsy more often than people without migraine. Changes in cortical excitability may help explain the pathophysiological link between both conditions, and could be a biomarker to monitor disease activity. In this thesis, the association between migraine and epilepsy and their relation to cortical excitability is further explored. A meta-analysis of previous population based studies provides epidemiological evidence for the co-occurrence of migraine and epilepsy. The combination of computer modelling with human electroencephalographic recordings offers insight into multi-stability of brain states in epilepsy. Results described in this thesis show that Transcranial Magnetic Stimulation can be used to measure cortical excitability, but that its use as a biomarker of disease activity in epilepsy is limited due to large interindividual variability. By combining Transcranial Magnetic Stimulation with electroencephalography, two novel variables that may contribute to cortical excitability are investigated: phase clustering, which possibly reflecting functional neuronal connectivity, and the non-linear residual of a stimulus-response curve, which may reflect brain state multi-stability. The results presented in this thesis suggest that the higher propensity to global synchronisation is not shared between epilepsy and migraine. These new variables have potential value to differentiate people with epilepsy, but not people with migraine, from normal controls.
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Dosani, Adnan 1982. « Exploring alternans characteristics of electrocardiogram for prediction of Paroxysmal Atrial Fibrillation ». Thesis, Massachusetts Institute of Technology, 2004. http://hdl.handle.net/1721.1/28726.
Texte intégralRésumé :
Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2004.Includes bibliographical references (leaves 93-96).
The goal of our thesis was to investigate if P-wave and PQ segment alternans can be used to detect and predict Paroxysmal Atrial Fibrillation (PAF) from an Electrocardiogram (ECG). The work involved implementing an algorithm for computing alternans information for a region of ECG, applying the algorithm to derive P-wave and PQ segment alternans information, and analyzing data generated for normal and PAF ECGs for evidence of any distinguishable predictive characteristics. Based on analysis of total 80 patient records (35 normal and 45 PAF) with validation on 30 records randomly selected from those (achieving c-indexes between 0.66 and 0.70), we concluded that alternans can potentially be a useful predictor for PAF.
by Adnan Dosani.
S.M.
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Kurdie, Sara. « FÖREKOMSTEN AV FOTO-PAROXYSMAL REAKTION HOS PATIENTER VID UTREDNING MED EEG ». Thesis, Malmö universitet, Malmö högskola, Institutionen för biomedicinsk vetenskap (BMV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-43296.
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Vid elektroencefalografi (EEG) används intermittent ljusstimulering för att detektera eventuell fotoparoxysmal reaktion (PPR) hos patienter, som tecken på en fotosensitivitet och stöd för en misstanke om epilepsi. Intermittent ljusstimulering innebär att patienten exponeras för en stroboskoplampa som ger ljus med frekvenser mellan 1–60 Hz. PPR karaktäriseras av spikes, spike-waves eller polyspike-waves som uppkommer bilateralt och synkront, symmetriskt och generaliserat. Intermittent ljusstimulering är en provokation som utförs vid rutin-EEG som tolkas på Skånes universitetssjukhus mellan 6 månader och 70 års ålder. Studier har dock visat att PPR sällan provoceras fram i äldre åldersgrupper. För äldre åldersgrupper kan det istället vara till större förmån att använda andra former av provokationer. Syftet med studien var att kartlägga förekomsten av PPR i olika åldersgrupper. Åldersfördelningen studerades på patienter med PPR som undersökts med rutin-EEG vilka tolkades på Skånes universitetssjukhus under perioden 2017-2020. Av 4050 rutin-EEG hade 3821 utfört intermittent ljusstimulering. Av dessa hade 1,4 % PPR med ett medelvärde av åldern på 17 år och standardavvikelse på 10 år. PPR var vanligare hos yngre (p<0,001) och 91 % av patienterna med PPR var under 30 år. PPR var även vanligare hos kvinnor (p<0,001) och motsvarade 84 % av undersökningarna med PPR. Konklusionen av studien är att PPR är vanligare hos kvinnor och patienter under 30 år.Electroencephalography (EEG) uses intermittent photic stimulation to detect possible photoparoxysmal response (PPR) in patients, as a sign of photosensitivity and as a contribution in the diagnosis of a suspected epilepsy. Intermittent photic stimulation means that the patient is exposed to flashing lights from a stroboscope lamp that provides light with frequencies between 1–60 Hz. PPR is characterized by spikes, spike-waves or polyspike-waves that occur bilaterally and synchronously, symmetrically and generalized. Intermittent photic stimulation is a provocation performed during routine-EEG that is interpreted at Skåne university hospital between 6 months and 70 years of age. However, studies have shown that PPR is rarely provoked in older age groups. For older age groups, it may instead be a greater advantage of using other forms of provocative methods. The purpose of this study was to map how common PPR is in different age groups. The age distribution was studied on patients with PPR who were examined with a routine EEG that was interpreted at Skåne university hospital during the period 2017-2020. Of the 4050 routine EEG, 3821 had performed intermittent photic stimulation. Of these 1.4 % had PPR with a mean age value of 17 years and a standard deviation of 10 years. PPR was more common in younger age groups (p<0.001) and 91% of the patients with PPR were younger than 30 years old. PPR was also more common in females (p <0.001), corresponding to 84 % of the examinations with PPR. The conclusion of the study is that PPR is more common in females and in patients younger than 30 years old.
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Malcolme-Lawes, Louisa. « A mechanistic basis for improving outcomes from paroxysmal atrial fibrillation ablation ». Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/12719.
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Pulmonary vein isolation (PVI) is a recommended treatment for drug-refractory paroxysmal atrial fibrillation. However, success rates remain around 50-70% for a single procedure despite advances in mapping and ablation technologies. PV reconnection is found in almost all patients with AF recurrence and therefore improving lesion durability is the focus of technological developments such as robotic manipulation. We demonstrated that robotic-assistance improves catheter stability compared to manual catheter guidance during AF ablation, resulting in greater electrogram attenuation at matched RF settings. However, this has not translated into improved outcomes in recent non-randomised trials, which may reflect that we only studied acute lesions. Several recent studies suggest that late-gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) can be used for studying chronic ablation lesions. We developed an automated LGE-CMR method to detect left atrial ablation scar and validated the technique by comparing co-located electrogram amplitude. A significant correlation between scar and endocardial low voltage was demonstrated. Interestingly, higher levels of pre-existing atrial scar were associated with lower success rates following ablation. Furthermore, whilst veins found to be isolated at the redo procedure had greater levels of ostial scar than reconnected veins, there was no difference in the amount of ostial scarring or the number of circumferentially scarred veins between patients with and without AF recurrence. This finding is in keeping with invasive studies which suggest that there is a significant degree of reconnection in asymptomatic patients and highlights inconsistencies in our understanding of PV mediated ectopy. It has been suggested that PVI inadvertently damages upstream regulators such as the atrial ganglionated plexi (GP) of the intrinsic cardiac autonomic nervous system and animal studies indicate that these may be potential targets for ablation to prevent AF. Continuous high frequency stimulation (HFS) of GPs produces AV block and this phenomenon has been used to identify and ablate the GPs as putative autonomic triggers for PV ectopy. However, animal studies have revealed a complex network of autonomic connections and these have not been investigated in detail in humans. We found that the right lower GP is the final common pathway to the AV node and must remain intact if all other GPs are to be identified and ablated. Heart rate variability has been suggested as a potential endpoint for autonomic modification. Using a novel intraprocedural, short-segment HRV tool, we found that the reduction in HRV following AF ablation occurs only after ablation of the right upper GP and therefore does not reflect the inputs from any other left atrial GP, precluding its use as an endpoint for left atrial denervation. Furthermore, it would seem logical to target the parts of the network that trigger PV ectopy rather than targeting GP sites that produce effects at the sinus node and AV node. We developed a technique to identify sites initiating ectopic triggers and found that the response could be abolished either by achieving PVI or by targeted RF ablation to the site. This raises the possibility of targeted autonomic denervation of culprit sites of atrial ectopy as an alternative strategy to PVI. These findings should now be applied prospectively to assess their impact on outcomes from AF ablation.
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Iyengar, Nikhil 1969. « P-wave electrical alternans as an indicator of paroxysmal atrial fibrillation ». Thesis, Massachusetts Institute of Technology, 1999. http://hdl.handle.net/1721.1/72313.
Texte intégralRésumé :
Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1999.Includes bibliographical references (leaves 95-97).
P-wave electrical alternans is a beat to beat alternation in the morphology of the P-wave, the wave in an electrocardiogram corresponding to atrial depolarization. In this investigation, software to measure p-wave alternans was developed and then tested on simulated data and on real data previously recorded from human subjects. The software consists of C programs managed by shell scripts and contains several features to minimize user interaction in data processing. The software can also calculate a signal averaged P-wave, apply various filters, and find the P-wave duration.
by Nikhil Iyengar.
M.Eng.
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Коленко, Оксана Іванівна, Оксана Ивановна Коленко, Oksana Ivanivna Kolenko et Л. Е. Бражник. « Случай пароксизмальной миоплегии ». Thesis, Издательство СумГУ, 2003. http://essuir.sumdu.edu.ua/handle/123456789/9243.
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Lyakisheva, Anna V. « Molecular analysis of the GPI-deficient clonal hematopoiesis in paroxysmal nocturnal hemoglobinuria ». [S.l.] : [s.n.], 2002. http://deposit.ddb.de/cgi-bin/dokserv?idn=964516861.
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Akin, Faith, Sherri Smith, Kristal M. Riska, Courtney D. Hall, Jennifer R. and Speech Lang Pathology Sears et A. Larkin. « The Development of the Benign Paroxysmal Positional Vertigo Symptom Impact Questionnaire (BSIQ) ». Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5396.
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Akin, Faith, Sherri Smith, Courtney D. Hall, Kristal M. Riska et Annabelle Larkin. « The Development of the Benign Paroxysmal Positional Vertigo Symptom Impact Questionnaire (BSIQ) ». Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5377.
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Akin, Faith W., Sherri L. Smith, Courtney D. Hall, Kristal M. Riska et Annabelle Larkin. « The Development of the Benign Paroxysmal Positional Vertigo Symptom Impact Questionnaire (BSIQ) ». Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5381.
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Lie-A-Huen, Loraine. « Pharmacokinetics and clinical pharmacology of flecainide in episodic treatment of paroxysmal atrial fibrillation ». [S.l. : [Groningen : s.n.] ; University of Groningen] [Host], 2008. http://irs.ub.rug.nl/ppn/.
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Suri, Nikita. « Superbursts : Investigation of Abnormal Paroxysmal Bursting Activity in Nerve Cell Networks In Vitro ». Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1157655/.
Texte intégralRésumé :
Superbursts (SBs) are large, seemingly spontaneous activity fluctuations often encountered in high density neural networks in vitro. Little effort has been put forth to define and analyze SBs which are paroxysmal bursting discharges. Through qualitative and quantitative means, I have described specific occurrences of superbursting activity. A complex of paroxysmal bursting has been termed a "superburst episode," and each individual SB is a "superburst event" which is comprises a fine burst structure. Quantitative calculations (employing overall spike summations and coefficient of variation (CV) calculations), reveal three distinct phases. Phase 1 is a "build up" phase of increasingly strong, coordinated bursting with an average of a 17.6% ± 13.7 increase in activity from reference. Phase 2, the "paroxysmal" phase, is comprised of massive coordinated bursting with high frequency spike content. Individual spike activity increases by 52.9% ± 14.6. Phase 3 is a "recovery phase" of lower coordination and an average of a 50.1% ± 35.6 decrease in spike production from reference. SBs can be induced and terminated by physical manipulation of the medium. Using a peristaltic pump with a flow rate of 0.4ml/min, superbursting activity ceases approximately 28.3 min after the introduction of flow. Alternatively, upon cessation of medium flow superbursting activity reemerges after approximately 8.5 min. Additionally, this study explored other methods capable of inducing superbursting activity using osmotic shocks. The induction and termination of SBs demonstrates that the cell culture environment plays a major role in generating this phenomenon. The observations that high density multi-layer neuronal networks in culture are more likely to enter paroxysmal bursting also supports the hypothesis that enrichment and depletion layers of metabolites and ionic species are involved in such unusual activity. The dynamic similarity of the SB phenomenon with epileptiform discharges make further quantification on the spike pattern level pertinent and important.
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Williams, L., Faith W. Akin, Courtney D. Hall, Kristal M. Riska, Stephanie M. Byrd et Owen D. Murnane. « A Benign Paroxysmal Positional Vertigo Specialty Clinic : A Model for Va Health Care ». Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/1884.
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ROMEI, ALESSANDRA. « Physiological role of PRRT2 and its involvement in the pathogenesis of paroxysmal disorders ». Doctoral thesis, Università degli studi di Genova, 2020. http://hdl.handle.net/11567/997607.
Texte intégralRésumé :
Mutations in the PRoline-Rich Transmembrane protein 2 gene (PRRT2) underlie a heterogeneous group of paroxysmal disorders encompassing infantile epilepsy, paroxysmal kinesigenic dyskinesia, a combination of these phenotypes and migraine. For the majority of the pathogenic PRRT2 variants, the mutant proteins are not expressed or not correctly targeted to the plasma membrane, resulting in a loss-of function mechanism for PRRT2-related diseases. PRRT2 is a neuron-specific, type II transmembrane protein of 340 amino acids with an important functional role in synapse formation and maintenance, as well as in the regulation of fast neurotransmitter release at both glutamatergic and GABAergic terminals. The PRRT2 knock-out (PRRT2-KO) mouse, in which PRRT2 has been constitutively inactivated, displays alterations in brain structure and a sharp paroxysmal phenotype, reminiscent of the most common clinical manifestations of the human PRRT2-linked diseases. To gain further insights on the pathogenic role of PRRT2 deficiency, I used Multi-Electrode Arrays (MEAs) to characterize neuronal activity generated by primary hippocampal cultures obtained from the PRRT2-KO mouse embryos and to assess the epileptic propensity of cortico-hippocampal slices obtained from the same animal model. This experimental approach revealed a state of heightened spontaneous activity, hyper-synchronization in population bursts of action potentials (APs) and enhanced responsiveness to external stimuli in mutant networks. A complex interplay between (i) a synaptic phenotype, with weakened spontaneous transmission and increased short-term facilitation, and (ii) a marked increase in intrinsic excitability of excitatory neurons as assessed by single-cell electrophysiology, upholds this network phenotype. Furthermore, our group has generated cortical neurons from induced pluripotent stem cells (iPSCs) derived from heterozygous and homozygous siblings carrying the most common C.649dupC mutation. Patch-clamp recordings in neurons from homozygous patients showed an increased Na+ current that was fully rescued by expression of exogenous wild-type PRRT2. A strikingly similar electrophysiological phenotype was observed in excitatory primary cortical neurons from the PRRT2-KO mouse, which was accompanied by an increased length of the axon initial segment (AIS). At the network level, mutant cortical neurons grown on MEAs also displayed a state of spontaneous and evoked hyper-excitability and elevated propensity to synchronize their activity in network bursting events.
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Eychenne, Julia. « Budgets éruptifs et origine des paroxysmes explosifs andésitiques en système ouvert : l'éruption d'août 2006 du Tungurahua en Equateur ». Phd thesis, Université Blaise Pascal - Clermont-Ferrand II, 2012. http://tel.archives-ouvertes.fr/tel-00741974.
Texte intégralRésumé :
Plusieurs volcans andésitiques dans le monde connaissent des périodes d'activité en système ouvert pendant plusieurs années, décennies voire siècles, qui sont caractérisées par des manifestations éruptives persistantes d'intensité fluctuante et ponctuées de phases explosives violentes et dangereuses, souvent accompagnées d'écoulements pyroclastiques. La compréhension de la dynamique et de l'origine de ces paroxysmes en système ouvert est un enjeu majeur de la recherche volcanologique dans le but d'améliorer la surveillance de ce type d'activité. Le Tungurahua en Equateur est un excellent exemple pour étudier un système andésitique ouvert : entré en activité en 1999, le volcan a connu une phase paroxysmale en août 2006, avec l'émission d'un panache éruptif de 15 km de hauteur et la mise en place d'écoulements pyroclastiques. Les objectifs de cette thèse sont, à partir de l'étude du dépôt de retombée, d'explorer la dynamique d'un volcan andésitique fonctionnant en système ouvert en étudiant le cas du paroxysme explosif du Tungurahua et de développer une méthode de suivi haute-résolution des budgets éruptifs massiques, transposable à différentes phases éruptives et différents volcans. A l'aide d'une déconvolution automatique des distributions granulométriques bimodales du dépôt, deux sous-populations ont été caractérisées et quantifiées. Ces dernières reflètent la syn-sédimentation de particules grossières depuis le panache éruptif, et de particules fines depuis des nuages co-écoulements pyroclastiques. Cette analyse granulométrique couplée à l'étude de l'amincissement du dépôt indiquent un volume total minimum de 42×106 m3 et un panache de 16-18 km au dessus du cratère. Cette éruption est classée comme une VEI 3 de type subplinien. Un nouveau protocole d'analyses de type et densité de clastes révèle une distribution sigmoïdale des densités des particules vésiculées avec la granulométrie. Cette loi empirique permet de déterminer la charge massique de chaque classe de constituants latéralement dans le dépôt à partir des données de comptage de grains. L'intégration des lois de décroissance massique exponentielle et puissance de chaque classe de constituant dans le dépôt permet d'estimer leur masse totale. Ces budgets massiques indiquent une magnitude~3,5 et une intensité ~9,2. La faible masse de ponces acides (<0.4 wt.%) exclus une origine par mélange de magma. Une proportion de ~98 wt.% et la faible densité de produits juvéniles révèle le caractère magmatique de l'éruption et l'absence d'interactions phréato-magmatiques. Les xénoclastes témoignent d'une fragmentation et d'une érosion des 2 km supérieurs du conduit. Des analyses morphologiques de particules menées avec un outil automatique et innovant (Morphologi G3 de Malvern) montrent le caractère hautement vésiculé des particules juvéniles et la faible viscosité de la lave. L'explosivité élevée d'août 2006 apparaît comme une manifestation extrême d'un système ouvert alimenté par des injections irrégulières de magma andésitique profond. L'activité du Tungurahua depuis 1999 définit un système caractérisé par un conduit très ouvert, une lave peu visqueuse et un dégazage par le biais d'explosions stromboliennes de faibles à hautes intensités. La méthode de détermination des budgets éruptifs est un atout majeur pour le suivi et la surveillance des phases éruptives en système ouvert.
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SOUBIRAN, CATHERINE. « Pointes ondes continues au cours du sommeil dans le syndrome de landau kleffner et l'epilepsie a paroxysmes rolandiques ». Toulouse 3, 1988. http://www.theses.fr/1988TOU31041.
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Hill, Anita. « The Role of Complement and Nitric Oxide in the Pathophysiology of Paroxysmal Nocturnal Haemoglobinuria ». Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.503289.
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Du, Charles Q. (Charles Qiao) 1980. « Prediction of Paroxysmal Atrial Fibrillation (PAF) onset through analysis of Inter-beat Intervals (IBI) ». Thesis, Massachusetts Institute of Technology, 2003. http://hdl.handle.net/1721.1/87389.
Texte intégralRésumé :
Thesis (M.Eng. and S.B.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2003.Includes bibliographical references (p. 64-65).
by Charles Q. Du.
M.Eng.and S.B.
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Cattani, Adriano. « Genesis of recurrent epileptic paroxysmal burst in newborn rats after inhibition of glutamate transporters ». Aix-Marseille 2, 2009. http://www.theses.fr/2009AIX22045.
Texte intégralRésumé :
Les Cell-surface transporteurs u glutamate contrôle de manière efficace les activités du réseau dans la maturation du cerveau des rongeurs : leur inhibition par le DL-TBOA conduit in vitro, en tranches coritcal (néocortex de l'hippocampe) à la génèse de depolarizations recurrent et salves de potentiels d'action dans les cellules pyramidales et les interneurones en alternance avec période de faible activité, une tendance que nous avons fait référence en tant que slow entwok oscilliations (SNOs). In vivo, l'inhibation génère des crises partielles et récurrentes paroxystiques rafales alteranant avec des périodes de silence, un modèle qui correspond à "suppression burst" (SB). Cette activité orticale est particulièrement intéressant car il est observé chez les nouveaux-nés souffrant de certaines formes de début de l'encéphalopathie épileptique ce qui soulève la possibilité que les transporteurs du glutamate pourrait être impliquée dans cette maladie. Les deux SNOs et SB impliqué l'activation des récepteurs NMDA, car ils ont tous deux été supprimés par les antagonistes des récepteurs NMDA suggérant qu'ils partagent les mêmes mécanismesCell-surface glutamate transpoters control efficiently entwork activities in maturing rodent brain : their inhibition by DL-TBOA leads in vitro, in cortical slices (neocortex and hippocampus) to the genesis of recurrent depolarizations and burst of action potentials in interneurons and pyramidal cells alternating with period of low activity, a pattern that we referred as slow network oscilliations (SNOs). In vivo, their inhibition generates partial seizures and also recurrent paroxylasmal bursts alternating with silent periods, a pattern that corresponds to "suppression burst" (SB). This cortical activity is particulary interestind since it is observed in neonates suffering forms of early epilecptic encephalopathy thus raising the possibility that glutamate transporters could be implated in this disease. Both SNOs and SB involved the activation of NMDA receptors since they were both abolished by NMDA receptor antagonists suggesting that they share similar mechanisms
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Akin, Faith W., Kristal M. Riska, Laura Williams, Stephanie B. Rouse et Owen D. Murnane. « Characteristics and Treatment Outcomes of Benign Paroxysmal Positional Vertigo in a Cohort of Veterans ». Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1780.
Texte intégralRésumé :
Background: The Mountain Home Veterans Affairs (VA) Medical Center has been diagnosing and treating veterans with benign paroxysmal positional vertigo (BPPV) for almost 2 decades. The clinic protocol includes a 2-week follow-up visit to determine the treatment outcome of the canalith repositioning treatment (CRT). To date, the characteristics of BPPV and treatment efficacy have not been reported in a cohort of veterans with BPPV.
Purpose: To determine the prevalence and characteristics of veterans diagnosed with BPPV in a Veterans Affairs Medical Center Audiology Clinic and to examine treatment outcomes.
Research Design: Retrospective chart review.
Study Sample: A total of 102 veterans who tested positive for BPPV in the Vestibular Clinic at the Mountain Home VA Medical Center from March 2010 to August 2011.
Results: In 102 veterans who were diagnosed with BPPV, the posterior semicircular canal was most often involved (75%), motion-provoked vertigo was the most common symptom (84%), and the majority (43%) were diagnosed with BPPV in their sixth decade. The prevalence of BPPV in the Audiology Vestibular Clinic was 15.6%. Forty-one percent of veterans reported a symptom onset within 12 months of treatment for BPPV; however, 36% reported their symptoms began > 36 months prior to treatment. CRT was effective (negative Dix–Hallpike/roll test) in most veterans (86%) following 1 treatment appointment (M = 1.6), but more than half reported incomplete symptom resolution (residual dizziness) at the follow-up appointment. Eighteen percent of veterans experienced a recurrence (M = 1.8 years; SD = 1.7 years).
Conclusions: The characteristics and treatment outcomes of BPPV in our veteran cohort was similar to what has been reported in the general population. Future work should focus on improving the timeliness of evaluation and treatment of BPPV and examining the time course and management of residual dizziness.
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Sim, Eyvonne Siew Siean. « Post Treatment Vertigo, Dizziness, and Unsteadiness in Older Adults with Benign Paroxysmal Positional Vertigo ». Thesis, Curtin University, 2021. http://hdl.handle.net/20.500.11937/88138.
Texte intégralRésumé :
Older adults are susceptible to Benign Paroxysmal Positional Vertigo (BPPV). While BPPV can be treated efficaciously with repositioning manoeuvres, some patients may experience residual dizziness and other problems. It is uncertain what factors are associated with residual dizziness in older adults. The evidence on treatment outcomes in older adults are conflicting and their experiences unexplored. This thesis aims to address these evidence gaps, and gain insight into the rehabilitation outcomes/experiences and residual dizziness in older adults with BPPV.
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GIANSANTE, GIORGIA. « The paroxysmal disorder gene PRRT2 downregulates NaV channels and neuronal excitability in human neurons ». Doctoral thesis, Università degli studi di Genova, 2018. http://hdl.handle.net/11567/929007.
Texte intégralRésumé :
Proline-Rich Transmembrane Protein 2 (PRRT2) has been identified as the single causative gene for a group of paroxysmal syndromes, including benign familial infantile seizures, paroxysmal kinesigenic dyskinesia and migraine. Most of the mutations of this gene lead to a premature stop codon, generating an unstable form of mRNA or a truncated protein that is degraded, pointing out the loss of the PRRT2 function as pathogenic mechanism of action. In this thesis, we have used different approaches to investigate the pathophysiological function of PRRT2. An important role for PRRT2 in the neurotransmitter release machinery, brain development and synapse formation has been uncovered by a previous work performed in our laboratory by acute silencing of PRRT2 expression. Here, we analyzed the phenotype of primary hippocampal neurons obtained from mouse PRRT2 knockout (KO) embryos. Analysis of synaptic function in primary neurons obtained from PRRT2-KO showed a largely similar, albeit attenuated, synaptic phenotype with respect to acute PRRT2 silencing characterized by weakened spontaneous/evoked synaptic transmission and increased facilitation at excitatory synapses. These effects were accompanied by a strengthened inhibitory transmission that, however, displayed faster synaptic depression. At the network level, these synaptic phenotypes, resulted in a state of increased spontaneous and evoked neurotransmitter release with increased excitability of excitatory neurons. To better dissect the physiological role of PRRT2, we characterized the phenotypes of neurons differentiated from Induced Pluripotent Stem Cells (iPSCs) from patients homozygous for the PRRT2 c.649dupC mutation. Hence, we observed an increased Na+ current and firing activity in iPSCs rescued with the re-expression of the human wild-type form of PRRT2. By use of heterologous expression system, we demonstrate that PRRT2 interacts with NaV1.2/NaV1.6, but not with NaV1.1 channels, modulating their membrane exposure and decreasing their conductances. In brief, our findings highlighted that PRRT2 mutations might be a negative modulator of NaV1.2/NaV1.6 channels and point out the critical role of this protein in the regulation of the neuronal network functionality.
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Rodovskaya, Liya. « Improving the Diagnosis and Management of Benign Paroxysmal Positional Vertigo in a Rural Healthcare Setting ». Diss., North Dakota State University, 2020. https://hdl.handle.net/10365/31914.
Texte intégralRésumé :
Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending.
This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence.
In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.
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Mortazavi, Yousef. « Molecular studies on the evolution of clonal disease in aplastic anaemia and paroxysmal nocturnal haemoglobinuria ». Thesis, St George's, University of London, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325079.
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Kodama, Itsuo, Kaichiro Kamiya, Yusuke Kuroda, Hideyuki Hasebe, Eriko Yokoyama, Toshiyuki Osaka et Yasunori Kushiyama. « Verapamil Eliminates the Hierarchical Nature of Activation Frequencies from the Pulmonary Veins to the Atria during Paroxysmal Atrial Fibrillation ». Thesis, Elsevier, 2010. http://hdl.handle.net/2237/16802.
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Du, Wei. « Role of KCNMA1 in the Pathogenesis of GEPD Syndrome ». Cleveland State University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=csu1272045934.
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Fertleman, Caroline Renee. « Molecular genetic analysis of an inherited disorder of paroxysmal pain and autonomic dysfunction : familial rectal pain ». Thesis, University of Cambridge, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.614125.
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Nabee, Mahomed Ridhwaan Goolam. « Demographic profile, clinical data and radiographic analysis of patients for third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape ». University of the Western Cape, 2018. http://hdl.handle.net/11394/6504.
Texte intégralRésumé :
Magister Scientiae Dentium - MSc(Dent)Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.
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Bowles, Alicia, Diana MD Trofimovitch et Jennifer MD Treece. « GI Bleed in a Hemodialysis Patient with Calciphylaxis and Paroxysmal Atrial Fibrillation : Should Warfarin therapy be continued ? » Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/147.
Texte intégralRésumé :
Calciphylaxis is a late complication of end-stage renal disease (ESRD) affecting ~1–4% patients on hemodialysis, with a mortality rate of >50%. Cutaneous manifestations include necrotic, non-healing ulcers most commonly in the lower extremities. Visceral organ vasculopathy often occurs as well. Warfarin is a possible risk factor due to its effect on the inhibition of Matrix GLa protein. Under the influence of hyperphosphatemia, vascular smooth muscle cells can undergo ectopic calcification in absence of the MGLa protein. The issue of anticoagulation in dialysis patients has therefore been debated, as Warfarin may potentially induce vasculopathy and increase risk of bleeding, such as hemorrhagic strokes and GI bleeds.
A 64-year-old male with ESRD, non-compliant with dialysis, presented with lower extremity pain. Patient was noted to have large, malodorous, bilateral lower extremity ulcers with necrosis and eschars. Punch biopsy of the ulcers demonstrated acute inflammation with calcium deposits and thrombi within the blood vessels, suggestive of Calciphylaxis. Patient was started on Sodium Thiosulfate and Sevelamer for hyperphosphatemia. Atrial fibrillation was incidentally found on EKG, and due to high risk of stroke based on the CHA2DS-VASc score, patient was started on Heparin and bridged to Warfarin on discharge. Patient was readmitted 3 months later to the ICU with septic shock. Lower extremity ulcers appeared to be healing, but he reported several episodes of hematochezia (INR=2.0, hemoglobin=5.2). Warfarin was therefore held and patient was transfused. EGD showed no evidence of upper GI bleed, however patient refused colonoscopy.
Patients on dialysis are at increased risk of bleeding due to defective primary hemostasis. The most serious source of bleeding is gastrointestinal, which accounts for 3–7% of all deaths in the dialysis population. Current guidelines for management of atrial fibrillation by the American Heart Association recommend warfarin for oral anticoagulation in patients with ESRD who have a CHA2DS2-VASc score of 2 or greater to prevent thromboembolic events. Our patient with ESRD and Calciphylaxis presented with new-onset atrial fibrillation and therefore started on Warfarin due to high CHA2DS2-VASc score. However patient developed a GI bleed with worsening anemia requiring transfusion, prompting discontinuation of Warfarin. It is therefore questionable whether the risk-benefit assessment based on CHA2DS2-VASc is appropriate for dialysis patients. Unfortunately, all the data available on the subject of Warfarin in ESRD patients are observational without any randomized-clinical trials. Therefore no objective criteria exist to modify the anticoagulation guidelines in dialysis patients.
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AlAhmad, Adnan [Verfasser], et Nikolaus [Akademischer Betreuer] Müller-Lantzsch. « The Antibody Repertoire of Patients with Paroxysmal Nocturnal Hemoglobinuria and Myelodysplastic Syndrome / Adnan AlAhmad. Betreuer : Nikolaus Müller-Lantzsch ». Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2011. http://d-nb.info/105109545X/34.
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Oi, Kazuki. « Low-dose perampanel improves refractory cortical myoclonus by the dispersed and suppressed paroxysmal depolarization shifts in the sensorimotor cortex ». Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263565.
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Hartl, Stefan Maximilian [Verfasser], et Ellen [Akademischer Betreuer] Hoffmann. « Pulmonary vein isolation with the second-generation cryoballoon in paroxysmal and persistent atrial fibrillation / Stefan Maximilian Hartl ; Betreuer : Ellen Hoffmann ». München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2018. http://d-nb.info/1156173051/34.
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Hicks, Courtney, Marc Fagelson, Kristal Riska et Kim Schairer. « Medical Students' Self-Perceived Preparedness in Managing Patients with BPPV ». Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/81.
Texte intégralRésumé :
Benign paroxysmal positional vertigo (BPPV) is a specific type of short-duration vertigo that is provoked by changes in head position and usually lasts less than one minute. It is a common vestibular pathology that can have significant effects on patient safety, quality of life, and medical costs. Therefore, it is crucial that medical students are educated and trained to facilitate and coordinate care of patients who may have undiagnosed BPPV. Because there is evidence to suggest that physicians—specifically primary care physicians—may not be properly equipped in their education to manage patients with BPPV, the purpose of this study was to investigate medical students’ evaluations of their preparedness to provide evidence-based care in the diagnosis and treatment of BPPV. An anonymous survey was administered via email to medical students in their fourth and final year of medical school at East Tennessee State University’s Quillen College of Medicine. This survey includes statements about the evidence-based Clinical Practice Guideline on BPPV provided by the American Academy of Otolaryngology. Respondents rated the degree to which they agreed or disagreed with how prepared they felt to address each item using a 5-point response scale from “strongly disagree” to “strongly agree.” Of the 70 students in the current fourth year class, 41 (59%) completed the survey. Students felt prepared for some aspects of diagnosing and treating BPPV, especially with regard to their general knowledge of BPPV, its impact on patients’ lives, and the options available to manage it. They felt less prepared to know when or if it is appropriate to recommend additional testing, imaging, or medication. They did not feel confident in their ability to perform the maneuvers to diagnose and treat BPPV. Overall, these results suggest medical students have a good foundation in their knowledge of BPPV. These results also propose topics to support more specialized training during their residencies to build upon the foundational knowledge obtained during their didactic training and optimize diagnosis and management of BPPV.
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DeBoodt, Jennifer L. « Treatment of Benign Paroxysmalvertigo : Necessity of Post-Maneuver Prohibition ». Scholar Commons, 2003. https://scholarcommons.usf.edu/etd/1353.
Texte intégralRésumé :
Benign paroxysmal positional vertigo (BPPV), characterized by a history of brief attacks of intense positional vertigo and rotary nystagmus, results from otoconial migration into the semicircular canals, making the sensory structures in the canal gravity sensitive. Treatment methods include positioning maneuvers, which return the otoconia back into the otolith, and typically include a variety of activity limitations for the subsequent 24-48 hours. Previous studies suggest BPPV treatment can be successful without any limitations of the patient post- therapy. The purpose of this study was to determine the necessity of post-maneuver restrictions on BPPV patients treated with the Canalith Repositioning Maneuver. Twenty participants were identified as having BPPV of the posterior canal and treated with the Canalith Repositioning Maneuver. During post-maneuver instruction, the ten participants assigned to the restricted group were provided with typical instructions. Ten participants assigned to the non-restricted group were given no post-maneuver restrictions. At the one-week post-treatment follow-up, all patients were free of vertigo and/or nystagmus. Results indicated that given two groups of subjects matched for age, gender, and symptoms, post-maneuver restrictions are not necessary for successful outcome using the CRM to treat posterior-canal BPPV.